{
  "Profile_Information": {
    "public_name": "Summit Community Care",
    "state": "ARKANSAS",
    "formulary_type": "Medicaid",
    "formulary_name": "Arkansas Medicaid",
    "formulary_id": 19875,
    "formulary_version": 49,
    "formulary_effective_date": "01/26/2026"
  },
  "Drug_Information": [
    {
      "ndc": "70529055012",
      "ndc_label_name": "12-Panel POC Toxicology System KIT In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189014410",
      "ndc_label_name": "1st Medx-Patch/ Lidocaine Patch 4-0.0375-5-20 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72137011315",
      "ndc_label_name": "1st Medx-Patch/ Lidocaine Patch 4-0.0375-5-20 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70175021101",
      "ndc_label_name": "2-Deoxy-D-Glucose POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452245203",
      "ndc_label_name": "2-Deoxy-D-Glucose POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998102",
      "ndc_label_name": "2-Deoxy-D-Glucose POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552057904",
      "ndc_label_name": "2-Deoxy-D-Glucose Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452245201",
      "ndc_label_name": "2-Deoxy-D-Glucose POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998101",
      "ndc_label_name": "2-Deoxy-D-Glucose POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452245202",
      "ndc_label_name": "2-Deoxy-D-Glucose POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552057901",
      "ndc_label_name": "2-Deoxy-D-Glucose POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552057902",
      "ndc_label_name": "2-Deoxy-D-Glucose POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927177300",
      "ndc_label_name": "2-Deoxy-D-Glucose POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052028401",
      "ndc_label_name": "2-Methoxyestradiol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927446100",
      "ndc_label_name": "2-Methoxyestradiol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144014210",
      "ndc_label_name": "2-Methoxyestradiol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08011000102",
      "ndc_label_name": "2-Way Foley Stabilization Dev",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927232500",
      "ndc_label_name": "4-Aminobutyric Acid CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552093904",
      "ndc_label_name": "4-Aminopyridine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927503000",
      "ndc_label_name": "4-Aminopyridine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144020105",
      "ndc_label_name": "4-Aminopyridine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927242300",
      "ndc_label_name": "4-Aminopyridine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052064501",
      "ndc_label_name": "4-Aminopyridine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144020110",
      "ndc_label_name": "4-Aminopyridine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927254100",
      "ndc_label_name": "4-Methylpyrazole Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452317501",
      "ndc_label_name": "5-Fluorouracil POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452317504",
      "ndc_label_name": "5-Fluorouracil POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452317503",
      "ndc_label_name": "5-Fluorouracil POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052050701",
      "ndc_label_name": "5-Fluorouracil Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052050705",
      "ndc_label_name": "5-Fluorouracil Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452317502",
      "ndc_label_name": "5-Fluorouracil POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452317505",
      "ndc_label_name": "5-Fluorouracil Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052050750",
      "ndc_label_name": "5-Fluorouracil Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991133302",
      "ndc_label_name": "5-Hydroxy-L-Tryptophan POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991133305",
      "ndc_label_name": "5-Hydroxy-L-Tryptophan POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991133304",
      "ndc_label_name": "5-Hydroxy-L-Tryptophan POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991133303",
      "ndc_label_name": "5-Hydroxy-L-Tryptophan POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552154601",
      "ndc_label_name": "5-Methyltetrahydrofolate Calc POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457996801",
      "ndc_label_name": "5-Methyltetrahydrofolate Calc POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927502800",
      "ndc_label_name": "5-Methyltetrahydrofolate Calc Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54288122201",
      "ndc_label_name": "5-Methyltetrahydrofolate Calc POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457996802",
      "ndc_label_name": "5-Methyltetrahydrofolate Calc POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70175020901",
      "ndc_label_name": "5-Methyltetrahydrofolate Calc POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927518000",
      "ndc_label_name": "5-Methyltetrahydrofolate Calc Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552154602",
      "ndc_label_name": "5-Methyltetrahydrofolate Calc POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552154603",
      "ndc_label_name": "5-Methyltetrahydrofolate Calc POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991310803",
      "ndc_label_name": "5-Methyltetrahydrofolate Calc POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991310802",
      "ndc_label_name": "5-Methyltetrahydrofolate Calc POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288122202",
      "ndc_label_name": "5-Methyltetrahydrofolate Calc POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457996803",
      "ndc_label_name": "5-Methyltetrahydrofolate Calc POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991310801",
      "ndc_label_name": "5-Methyltetrahydrofolate Calc POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779241804",
      "ndc_label_name": "7-Keto DHEA POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552101702",
      "ndc_label_name": "7-Keto DHEA POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779241809",
      "ndc_label_name": "7-Keto DHEA Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779241803",
      "ndc_label_name": "7-Keto DHEA POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991250501",
      "ndc_label_name": "7-Keto DHEA Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779241805",
      "ndc_label_name": "7-Keto DHEA POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991250504",
      "ndc_label_name": "7-Keto DHEA Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452244901",
      "ndc_label_name": "7-Keto DHEA Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552101703",
      "ndc_label_name": "7-Keto DHEA POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552101705",
      "ndc_label_name": "7-Keto DHEA POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552101704",
      "ndc_label_name": "7-Keto DHEA POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779241808",
      "ndc_label_name": "7-Keto DHEA POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991250503",
      "ndc_label_name": "7-Keto DHEA Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452244903",
      "ndc_label_name": "7-Keto DHEA Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452244902",
      "ndc_label_name": "7-Keto DHEA Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927334100",
      "ndc_label_name": "7-Keto DHEA POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452244904",
      "ndc_label_name": "7-Keto DHEA Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991250502",
      "ndc_label_name": "7-Keto DHEA Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70645080426",
      "ndc_label_name": "7T Lido Gel 2 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927153800",
      "ndc_label_name": "9-Aminoacridine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50488200302",
      "ndc_label_name": "A.A.G.C. Kit in TeroDerm CREAM 8-4-10-4 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50488200301",
      "ndc_label_name": "A.A.G.C. Kit in TeroDerm CREAM 8-4-10-4 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121089720",
      "ndc_label_name": "Abacavir Sulfate Solution 20 MG/ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980040524",
      "ndc_label_name": "Abacavir Sulfate Solution 20 MG/ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722056224",
      "ndc_label_name": "Abacavir Sulfate SOLUTION 20 MG/ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121089715",
      "ndc_label_name": "Abacavir Sulfate Solution 20 MG/ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079020401",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904687404",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904687406",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865016701",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007360",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378410591",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268004912",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722055760",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380071703",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268004911",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084002111",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079020406",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084002121",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097051403",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518127400",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865016760",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097036202",
      "ndc_label_name": "Abacavir Sulfate-Lamivudine TABLET 600-300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291011530",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35573040230",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35573043030",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722083830",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385096230",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862033530",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180028806",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57665010141",
      "ndc_label_name": "Abelcet Suspension 5 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700030384",
      "ndc_label_name": "Abigale Lo Tablet 0.5-0.1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700030385",
      "ndc_label_name": "Abigale Lo Tablet 0.5-0.1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700033084",
      "ndc_label_name": "Abigale Tablet 1-0.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700033085",
      "ndc_label_name": "Abigale Tablet 1-0.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148010280",
      "ndc_label_name": "Abilify Asimtufii Prefilled Syringe 720 MG/2.4ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148011492",
      "ndc_label_name": "Abilify Asimtufii Prefilled Syringe 960 MG/3.2ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148011480",
      "ndc_label_name": "Abilify Asimtufii Prefilled Syringe 960 MG/3.2ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148004580",
      "ndc_label_name": "Abilify Maintena Prefilled Syringe 300 MG Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148007280",
      "ndc_label_name": "Abilify Maintena Prefilled Syringe 400 MG Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148001871",
      "ndc_label_name": "Abilify Maintena Suspension Reconstituted ER 300 MG Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148023212",
      "ndc_label_name": "Abilify Maintena Suspension Reconstituted ER 300 MG Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148001870",
      "ndc_label_name": "Abilify Maintena Suspension Reconstituted ER 300 MG Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148001970",
      "ndc_label_name": "Abilify Maintena Suspension Reconstituted ER 400 MG Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148001971",
      "ndc_label_name": "Abilify Maintena Suspension Reconstituted ER 400 MG Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148024512",
      "ndc_label_name": "Abilify Maintena Suspension Reconstituted ER 400 MG Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148003172",
      "ndc_label_name": "Abilify MyCite Maintenance Kit Tablet Therapy Pack 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148003272",
      "ndc_label_name": "Abilify MyCite Maintenance Kit Tablet Therapy Pack 15 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148002972",
      "ndc_label_name": "Abilify MyCite Maintenance Kit Tablet Therapy Pack 2 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148003372",
      "ndc_label_name": "Abilify MyCite Maintenance Kit Tablet Therapy Pack 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148003472",
      "ndc_label_name": "Abilify MyCite Maintenance Kit Tablet Therapy Pack 30 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148003072",
      "ndc_label_name": "Abilify MyCite Maintenance Kit Tablet Therapy Pack 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148003161",
      "ndc_label_name": "Abilify MyCite Starter Kit Tablet Therapy Pack 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148003261",
      "ndc_label_name": "Abilify MyCite Starter Kit Tablet Therapy Pack 15 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148002961",
      "ndc_label_name": "Abilify MyCite Starter Kit Tablet Therapy Pack 2 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148003361",
      "ndc_label_name": "Abilify MyCite Starter Kit Tablet Therapy Pack 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148003461",
      "ndc_label_name": "Abilify MyCite Starter Kit Tablet Therapy Pack 30 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148003061",
      "ndc_label_name": "Abilify MyCite Starter Kit Tablet Therapy Pack 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148003185",
      "ndc_label_name": "Abilify MyCite Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148003285",
      "ndc_label_name": "Abilify MyCite Tablet 15 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148002985",
      "ndc_label_name": "Abilify MyCite Tablet 2 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148003385",
      "ndc_label_name": "Abilify MyCite Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148003485",
      "ndc_label_name": "Abilify MyCite Tablet 30 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148003085",
      "ndc_label_name": "Abilify MyCite Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353084816",
      "ndc_label_name": "Abilify Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353084815",
      "ndc_label_name": "Abilify Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289025130",
      "ndc_label_name": "Abilify Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959060530",
      "ndc_label_name": "Abilify Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353084845",
      "ndc_label_name": "Abilify Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148000813",
      "ndc_label_name": "Abilify TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071079415",
      "ndc_label_name": "Abilify TABLET 15 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148000913",
      "ndc_label_name": "Abilify TABLET 15 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148000613",
      "ndc_label_name": "Abilify TABLET 2 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353084945",
      "ndc_label_name": "Abilify Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353084915",
      "ndc_label_name": "Abilify Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353084916",
      "ndc_label_name": "Abilify Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148001013",
      "ndc_label_name": "Abilify TABLET 20 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353085015",
      "ndc_label_name": "Abilify Tablet 30 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353085045",
      "ndc_label_name": "Abilify Tablet 30 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353085099",
      "ndc_label_name": "Abilify Tablet 30 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353085018",
      "ndc_label_name": "Abilify Tablet 30 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148001113",
      "ndc_label_name": "Abilify TABLET 30 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289056630",
      "ndc_label_name": "Abilify TABLET 30 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59148000713",
      "ndc_label_name": "Abilify TABLET 5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959060430",
      "ndc_label_name": "Abilify Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714096301",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093112589",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904694804",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143959721",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505432701",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57894015512",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687045511",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378692078",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42292005703",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291002412",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687079021",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219116507",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687079011",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009013912",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687045521",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42292005701",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407018112",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598035804",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82293000110",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001048907",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679002101",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629942901",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921017820",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789021398",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980041812",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238116507",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603011001",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907022404",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462013508",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205028492",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82249001012",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205003092",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72606056601",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378692191",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001067306",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505476406",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291007360",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72606057301",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603011101",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591436560",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162215106",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462088260",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82293000210",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629943001",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238175406",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598046860",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205028560",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219175406",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009014060",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921017706",
      "ndc_label_name": "Abiraterone Acetate Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82249001112",
      "ndc_label_name": "Abirtega Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069032501",
      "ndc_label_name": "Abrilada (1 Pen) Auto-Injector Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025032501",
      "ndc_label_name": "Abrilada (1 Pen) Auto-Injector Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069032502",
      "ndc_label_name": "Abrilada (2 Pen) Auto-Injector Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025032502",
      "ndc_label_name": "Abrilada (2 Pen) Auto-Injector Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025033302",
      "ndc_label_name": "Abrilada (2 Syringe) Prefilled Syringe Kit 20 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069033302",
      "ndc_label_name": "Abrilada (2 Syringe) Prefilled Syringe Kit 20 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069032802",
      "ndc_label_name": "Abrilada (2 Syringe) Prefilled Syringe Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025032802",
      "ndc_label_name": "Abrilada (2 Syringe) Prefilled Syringe Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069034401",
      "ndc_label_name": "Abrysvo Solution Reconstituted 120 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069246501",
      "ndc_label_name": "Abrysvo Solution Reconstituted 120 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069034405",
      "ndc_label_name": "Abrysvo Solution Reconstituted 120 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069246519",
      "ndc_label_name": "Abrysvo Solution Reconstituted 120 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069246510",
      "ndc_label_name": "Abrysvo Solution Reconstituted 120 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10631011531",
      "ndc_label_name": "Absorica Capsule 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631011569",
      "ndc_label_name": "Absorica Capsule 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118994003",
      "ndc_label_name": "Absorica Capsule 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631011669",
      "ndc_label_name": "Absorica Capsule 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631011631",
      "ndc_label_name": "Absorica Capsule 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631013331",
      "ndc_label_name": "Absorica Capsule 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631013369",
      "ndc_label_name": "Absorica Capsule 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631011731",
      "ndc_label_name": "Absorica Capsule 30 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631011769",
      "ndc_label_name": "Absorica Capsule 30 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631013469",
      "ndc_label_name": "Absorica Capsule 35 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631013431",
      "ndc_label_name": "Absorica Capsule 35 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631011869",
      "ndc_label_name": "Absorica Capsule 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631011831",
      "ndc_label_name": "Absorica Capsule 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631000331",
      "ndc_label_name": "Absorica LD Capsule 16 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631000531",
      "ndc_label_name": "Absorica LD Capsule 24 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631000731",
      "ndc_label_name": "Absorica LD Capsule 32 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631000231",
      "ndc_label_name": "Absorica LD Capsule 8 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927443100",
      "ndc_label_name": "AC Dermapeptide Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840540004",
      "ndc_label_name": "Acacia Pollen Solution 1:40 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840540002",
      "ndc_label_name": "Acacia Pollen Solution 1:40 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779006005",
      "ndc_label_name": "Acacia POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452344002",
      "ndc_label_name": "Acacia POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552006506",
      "ndc_label_name": "Acacia POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779006001",
      "ndc_label_name": "Acacia POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991133202",
      "ndc_label_name": "Acacia POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991133201",
      "ndc_label_name": "Acacia POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779006008",
      "ndc_label_name": "Acacia POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552006504",
      "ndc_label_name": "Acacia POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452344005",
      "ndc_label_name": "Acacia Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452344001",
      "ndc_label_name": "Acacia POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991133203",
      "ndc_label_name": "Acacia POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00378633380",
      "ndc_label_name": "Acamprosate Calcium TABLET DELAYED RELEASE 333 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462043518",
      "ndc_label_name": "Acamprosate Calcium TABLET DELAYED RELEASE 333 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382056928",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904721304",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093535286",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687012195",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291010418",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063632",
      "ndc_label_name": "Acamprosate Calcium TABLET DELAYED RELEASE 333 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452035325",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687012125",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000502",
      "ndc_label_name": "Acarbose Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052065601",
      "ndc_label_name": "Acarbose Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000501",
      "ndc_label_name": "Acarbose Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000503",
      "ndc_label_name": "Acarbose Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000504",
      "ndc_label_name": "Acarbose Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090582900",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054014225",
      "ndc_label_name": "Acarbose TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155014901",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085611",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135045590",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085678",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380076006",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543012210",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543012211",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085600",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291013290",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085630",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789013330",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085655",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085672",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085660",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789013360",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789013390",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085690",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085411",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135045390",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085490",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380075806",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085455",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291013090",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155014701",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054014025",
      "ndc_label_name": "Acarbose TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085400",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789013130",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789013160",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543012010",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789013190",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085430",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543012011",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085472",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085460",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085478",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054014125",
      "ndc_label_name": "Acarbose TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380075906",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085572",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085511",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353095109",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543012110",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155014801",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085578",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085590",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085500",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291013190",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085555",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135045490",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543012111",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789013230",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085530",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789013260",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085560",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789013290",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884058902",
      "ndc_label_name": "Accolate Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380017701",
      "ndc_label_name": "Accolate Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884059002",
      "ndc_label_name": "Accolate Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380017801",
      "ndc_label_name": "Accolate Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73059000160",
      "ndc_label_name": "ACCRUFeR Capsule 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "15630882755",
      "ndc_label_name": "Accu-Chek Spirit Cartridge",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15630088863",
      "ndc_label_name": "Accu-Chek Ultraflex-1 Inf Set",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15630088862",
      "ndc_label_name": "Accu-Chek Ultraflex-1 Inf Set",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60006011821",
      "ndc_label_name": "Accula SARS-CoV-2 Kit In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00071053023",
      "ndc_label_name": "Accupril Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00071053223",
      "ndc_label_name": "Accupril Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00071053523",
      "ndc_label_name": "Accupril Tablet 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00071052723",
      "ndc_label_name": "Accupril Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00071311223",
      "ndc_label_name": "Accuretic Tablet 10-12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00071521223",
      "ndc_label_name": "Accuretic Tablet 20-12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23731605305",
      "ndc_label_name": "ACD-A noClot-50 SOLUTION 0.73-2.45-2.2 GM/100ML IN VITRO",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746066901",
      "ndc_label_name": "Acebutolol HCl CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407066601",
      "ndc_label_name": "Acebutolol HCl Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268005011",
      "ndc_label_name": "Acebutolol HCl CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268005015",
      "ndc_label_name": "Acebutolol HCl CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559025501",
      "ndc_label_name": "Acebutolol HCl Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063001",
      "ndc_label_name": "Acebutolol HCl CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291001001",
      "ndc_label_name": "Acebutolol HCl Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063101",
      "ndc_label_name": "Acebutolol HCl CAPSULE 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407066701",
      "ndc_label_name": "Acebutolol HCl Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746067001",
      "ndc_label_name": "Acebutolol HCl CAPSULE 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559025601",
      "ndc_label_name": "Acebutolol HCl Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927290600",
      "ndc_label_name": "Acebutolol HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779017208",
      "ndc_label_name": "Acepromazine Maleate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991298103",
      "ndc_label_name": "Acepromazine Maleate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991298102",
      "ndc_label_name": "Acepromazine Maleate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779017209",
      "ndc_label_name": "Acepromazine Maleate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991298101",
      "ndc_label_name": "Acepromazine Maleate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779017204",
      "ndc_label_name": "Acepromazine Maleate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779017205",
      "ndc_label_name": "Acepromazine Maleate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991298104",
      "ndc_label_name": "Acepromazine Maleate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927357400",
      "ndc_label_name": "Acepromazine Maleate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552127705",
      "ndc_label_name": "Acesulfame Potassium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452344903",
      "ndc_label_name": "Acesulfame Potassium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779259009",
      "ndc_label_name": "Acesulfame Potassium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452344901",
      "ndc_label_name": "Acesulfame Potassium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779259005",
      "ndc_label_name": "Acesulfame Potassium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779317104",
      "ndc_label_name": "Acesulfame Potassium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779259004",
      "ndc_label_name": "Acesulfame Potassium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779259008",
      "ndc_label_name": "Acesulfame Potassium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991256804",
      "ndc_label_name": "Acesulfame Potassium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452344904",
      "ndc_label_name": "Acesulfame Potassium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779317108",
      "ndc_label_name": "Acesulfame Potassium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452344902",
      "ndc_label_name": "Acesulfame Potassium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779317105",
      "ndc_label_name": "Acesulfame Potassium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779317109",
      "ndc_label_name": "Acesulfame Potassium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927439800",
      "ndc_label_name": "Acesulfame Potassium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991256801",
      "ndc_label_name": "Acesulfame Potassium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991256803",
      "ndc_label_name": "Acesulfame Potassium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552127704",
      "ndc_label_name": "Acesulfame Potassium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63307001011",
      "ndc_label_name": "Acesulfame Potassium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991256802",
      "ndc_label_name": "Acesulfame Potassium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307001015",
      "ndc_label_name": "Acesulfame Potassium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66220020730",
      "ndc_label_name": "Acetadote SOLUTION 200 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991269003",
      "ndc_label_name": "Acetaminophen CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991269004",
      "ndc_label_name": "Acetaminophen CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000905",
      "ndc_label_name": "Acetaminophen GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000902",
      "ndc_label_name": "Acetaminophen GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000901",
      "ndc_label_name": "Acetaminophen GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991100202",
      "ndc_label_name": "Acetaminophen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452001003",
      "ndc_label_name": "Acetaminophen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452001005",
      "ndc_label_name": "Acetaminophen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779040905",
      "ndc_label_name": "Acetaminophen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779040907",
      "ndc_label_name": "Acetaminophen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452001002",
      "ndc_label_name": "Acetaminophen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779040909",
      "ndc_label_name": "Acetaminophen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779040901",
      "ndc_label_name": "Acetaminophen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991100203",
      "ndc_label_name": "Acetaminophen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452001006",
      "ndc_label_name": "Acetaminophen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60592000145",
      "ndc_label_name": "Acetaminophen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779040908",
      "ndc_label_name": "Acetaminophen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927263300",
      "ndc_label_name": "Acetaminophen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552008606",
      "ndc_label_name": "Acetaminophen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552008607",
      "ndc_label_name": "Acetaminophen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452001001",
      "ndc_label_name": "Acetaminophen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60592000101",
      "ndc_label_name": "Acetaminophen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552008604",
      "ndc_label_name": "Acetaminophen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991100206",
      "ndc_label_name": "Acetaminophen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000105",
      "ndc_label_name": "Acetaminophen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000110",
      "ndc_label_name": "Acetaminophen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000111",
      "ndc_label_name": "Acetaminophen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64950037416",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121050400",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121100800",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999032304",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856007902",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121050404",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121050405",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856007905",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090021500",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856007901",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383033705",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959014103",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121050416",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383033706",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121050440",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959014104",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383007916",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383033912",
      "ndc_label_name": "Acetaminophen-Codeine Solution 300-30 MG/12.5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383033913",
      "ndc_label_name": "Acetaminophen-Codeine Solution 300-30 MG/12.5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121100812",
      "ndc_label_name": "Acetaminophen-Codeine Solution 300-30 MG/12.5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121100840",
      "ndc_label_name": "Acetaminophen-Codeine Solution 300-30 MG/12.5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093005001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959020830",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629294501",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629118501",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025915",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025902",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629118701",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048301",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025901",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025920",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025924",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025904",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025912",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267022130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850064105",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603233721",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025960",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025950",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380044801",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107005801",
      "ndc_label_name": "Acetaminophen-Codeine TABLET 300-15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850064101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005452",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959020815",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025930",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005412",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093015001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702081",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406048423",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702620",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702015",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406048403",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406048462",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406048401",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093015010",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702690",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702020",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702630",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702610",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702085",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702603",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702010",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406048410",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544010015",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702030",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702685",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702640",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702604",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702691",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702606",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702012",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12634052680",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702612",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000104",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000164",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544003215",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603233832",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702615",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702650",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000160",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702660",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000190",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544003220",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000103",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000102",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107005999",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000172",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440702681",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000184",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358000115",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107005901",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000114",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000107",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000112",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999006060",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603233821",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358000190",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358000140",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000110",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000124",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000115",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000118",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090157301",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10544010020",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353001070",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358000150",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000120",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000150",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000128",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000121",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090157400",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358000120",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999006030",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999006050",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000125",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358000101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353001075",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000142",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090461101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999006020",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090461004",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999006090",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000140",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358000160",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999006001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261000148",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090520004",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090193401",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090461007",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090387100",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358000130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353001050",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090193301",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358000100",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000325",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090461001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090520001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090461000",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353001060",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353001090",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090193307",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353001045",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000340",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090520000",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090520007",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090461003",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090157200",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090157202",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079016120",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999006024",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000350",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000316",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436322707",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090520003",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090157203",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090193302",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919002390",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090157201",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002010110",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000345",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000324",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079016101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090193304",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090193303",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919005360",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090157204",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002010115",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002010120",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000360",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000390",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000300",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090520002",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919005371",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090157207",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348001510",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760046630",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687060401",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118056203",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000302",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000328",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020230",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090193300",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687060411",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919032830",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919048490",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118056206",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000306",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000342",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380044603",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090193500",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919002330",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919032871",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187081530",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760058130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000315",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020220",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000124",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090461002",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187010615",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919048418",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629118801",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919048430",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000320",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000184",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000304",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187010630",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187081515",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020206",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020216",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000330",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000120",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544000260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000310",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020228",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020212",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020210",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020224",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919048410",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544000220",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788783501",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000312",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000110",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020214",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020215",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020250",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187081560",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544000275",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788783503",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000375",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544000215",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020290",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020225",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380044601",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020205",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544000280",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205000130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000384",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544000230",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000106",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020242",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020208",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544088230",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335025608",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002010130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544000250",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000112",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64850064205",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544000270",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64850064201",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544088272",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335054502",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919002371",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788950606",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000115",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162003311",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544088250",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162003310",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544088275",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335054505",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919032890",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335054501",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544000240",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000190",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084037201",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000160",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544088280",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335054508",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187081520",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335054507",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544000255",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000191",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780103",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544000245",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788028503",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610011190",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629149410",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420010320",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544088245",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544000272",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780106",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544000254",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420082100",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020201",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420082101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544088253",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544000285",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788783506",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544000290",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780102",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420082103",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020202",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420082130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205000115",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544088220",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420082115",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544000293",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788783502",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420082105",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020204",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425052901",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335025600",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544088254",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804018130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544088290",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335054506",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420082110",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020218",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425052902",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335025603",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544088260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63874020240",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788028506",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335152209",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420082112",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000140",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335025601",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335152203",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084037211",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544000246",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335025605",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610011130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420082120",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544000253",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335025606",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425052701",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518021200",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544088240",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335054500",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610011146",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420082150",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544088246",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335054503",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425052903",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518262800",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544088255",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335152202",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610011170",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335025602",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544088270",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335152205",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610011175",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335025607",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788950603",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335152208",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420010303",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335054509",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518298900",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610011154",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420010330",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335181809",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335025604",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930005512",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335025609",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610011153",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335054504",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930005552",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610011145",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610011160",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610011172",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162200101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162200105",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610011180",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420010310",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420082160",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420082190",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425052703",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425052702",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406048501",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093035001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000210",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107006001",
      "ndc_label_name": "Acetaminophen-Codeine TABLET 300-60 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107006005",
      "ndc_label_name": "Acetaminophen-Codeine TABLET 300-60 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000248",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093035010",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093035005",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107006099",
      "ndc_label_name": "Acetaminophen-Codeine TABLET 300-60 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000221",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000230",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000208",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000202",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000230",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090301101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048505",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000228",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000240",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000214",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000212",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026730",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044620",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603233921",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000256",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687061501",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000242",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000220",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000290",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544047470",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629303103",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603233928",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000200",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919047260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002630",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002660",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544047490",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267100500",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044600",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002640",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629119001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002601",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002690",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026702",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780203",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084037301",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044602",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026708",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629303105",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044624",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919047290",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026704",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785903",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084037311",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044630",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000230",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026701",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044650",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090560",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026712",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785906",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780202",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304056101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000370",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026703",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044660",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629303101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026720",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162200201",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788973609",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629303104",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000390",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026710",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687061511",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380044702",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026715",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162200205",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026728",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780201",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026750",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919027390",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000220",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888206",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026760",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425052802",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850064305",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335033603",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026790",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629303102",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000240",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788973602",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850064301",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425053003",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000353",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335033606",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544047480",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026705",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785902",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335070101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888203",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026740",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000360",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380044701",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788973601",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544047460",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888103",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518305100",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888201",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000380",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788973603",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335033601",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788973606",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888106",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005612",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335070103",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189037660",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544047453",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425052801",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335184604",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425053001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780206",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425053002",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785901",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518276400",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005652",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425052803",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51927429300",
      "ndc_label_name": "Acetarsone POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552085505",
      "ndc_label_name": "AcetaZOLAMIDE CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090594500",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729033101",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29033003001",
      "ndc_label_name": "AcetaZOLAMIDE ER CAPSULE EXTENDED RELEASE 12 HOUR 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135061260",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571024301",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155012001",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090313200",
      "ndc_label_name": "AcetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687057821",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367020901",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155078701",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268004211",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268004212",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742023301",
      "ndc_label_name": "AcetaZOLAMIDE ER CAPSULE EXTENDED RELEASE 12 HOUR 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687057811",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332034931",
      "ndc_label_name": "AcetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710159101",
      "ndc_label_name": "AcetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779041004",
      "ndc_label_name": "AcetaZOLAMIDE POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452001804",
      "ndc_label_name": "AcetaZOLAMIDE POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991251701",
      "ndc_label_name": "AcetaZOLAMIDE POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927227600",
      "ndc_label_name": "AcetaZOLAMIDE POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779041005",
      "ndc_label_name": "AcetaZOLAMIDE POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991251702",
      "ndc_label_name": "AcetaZOLAMIDE POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779041009",
      "ndc_label_name": "AcetaZOLAMIDE POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452001805",
      "ndc_label_name": "AcetaZOLAMIDE Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779041007",
      "ndc_label_name": "AcetaZOLAMIDE POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991251704",
      "ndc_label_name": "AcetaZOLAMIDE POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991251705",
      "ndc_label_name": "AcetaZOLAMIDE POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452001802",
      "ndc_label_name": "AcetaZOLAMIDE POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452001803",
      "ndc_label_name": "AcetaZOLAMIDE POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991251703",
      "ndc_label_name": "AcetaZOLAMIDE POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457085350",
      "ndc_label_name": "AcetaZOLAMIDE Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143900601",
      "ndc_label_name": "acetaZOLAMIDE Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155083131",
      "ndc_label_name": "acetaZOLAMIDE Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822019001",
      "ndc_label_name": "AcetaZOLAMIDE Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155031331",
      "ndc_label_name": "acetaZOLAMIDE Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143950301",
      "ndc_label_name": "AcetaZOLAMIDE Sodium SOLUTION RECONSTITUTED 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090451101",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155028701",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817020010",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289072012",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672402201",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289072006",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135077201",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090561701",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888004701",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008901",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578014901",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756072011",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651090501",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135060712",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090057701",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789023801",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380083306",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629119401",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991088401",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954003330",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789004512",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205030830",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930000812",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789004506",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162197801",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81005010401",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739025701",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090559300",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527105001",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135056701",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904666361",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090753600",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155028801",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268005411",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789023701",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81005010501",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090300300",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672402301",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135077301",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084054111",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268005415",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651090601",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291009001",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162197901",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954003430",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991088501",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291010310",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687061901",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629119501",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817020110",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999089212",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135060812",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084054101",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930000912",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687061911",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380083406",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756072111",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888004801",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578015001",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452003001",
      "ndc_label_name": "Acetic Acid Glacial SOLUTION 99 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779058201",
      "ndc_label_name": "Acetic Acid Glacial SOLUTION 99 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552020905",
      "ndc_label_name": "Acetic Acid Glacial SOLUTION 99 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452003003",
      "ndc_label_name": "Acetic Acid Glacial SOLUTION 99 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991274501",
      "ndc_label_name": "Acetic Acid Glacial SOLUTION 99 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779058208",
      "ndc_label_name": "Acetic Acid Glacial SOLUTION 99 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927129700",
      "ndc_label_name": "Acetic Acid Glacial SOLUTION 99 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991274502",
      "ndc_label_name": "Acetic Acid Glacial SOLUTION 99 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990614322",
      "ndc_label_name": "Acetic Acid Solution 0.25 % Irrigation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264230400",
      "ndc_label_name": "Acetic Acid SOLUTION 0.25 % IRRIGATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264230410",
      "ndc_label_name": "Acetic Acid SOLUTION 0.25 % IRRIGATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338065604",
      "ndc_label_name": "Acetic Acid SOLUTION 0.25 % IRRIGATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990614309",
      "ndc_label_name": "Acetic Acid Solution 0.25 % Irrigation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817081615",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383088915",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090035100",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432074115",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135080151",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090626300",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090302000",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432074116",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090652700",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700042415",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700098615",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980042415",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552005106",
      "ndc_label_name": "Acetic Acid SOLUTION 3 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552005506",
      "ndc_label_name": "Acetic Acid SOLUTION 5 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552005508",
      "ndc_label_name": "Acetic Acid SOLUTION 5 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452005003",
      "ndc_label_name": "Acetone SOLUTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452005002",
      "ndc_label_name": "Acetone SOLUTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552023805",
      "ndc_label_name": "Acetone SOLUTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452005001",
      "ndc_label_name": "Acetone SOLUTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00395001916",
      "ndc_label_name": "Acetone Solution",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00395001928",
      "ndc_label_name": "Acetone Solution",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50483330024",
      "ndc_label_name": "Acetone SOLUTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50483330004",
      "ndc_label_name": "Acetone SOLUTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00395001994",
      "ndc_label_name": "Acetone Solution",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927188800",
      "ndc_label_name": "Acetone SOLUTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991283902",
      "ndc_label_name": "Acetone SOLUTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50483330005",
      "ndc_label_name": "Acetone SOLUTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991283903",
      "ndc_label_name": "Acetone SOLUTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991283901",
      "ndc_label_name": "Acetone SOLUTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552023804",
      "ndc_label_name": "Acetone SOLUTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552023809",
      "ndc_label_name": "Acetone SOLUTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927377100",
      "ndc_label_name": "Acetyl Dipeptide-1 Cetyl Ester SOLUTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779291605",
      "ndc_label_name": "Acetyl Hexapeptide-8 POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927369700",
      "ndc_label_name": "Acetyl Hexapeptide-8 SOLUTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779095501",
      "ndc_label_name": "Acetyl Salicylic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779095505",
      "ndc_label_name": "Acetyl Salicylic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779095509",
      "ndc_label_name": "Acetyl Salicylic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779095507",
      "ndc_label_name": "Acetyl Salicylic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779095508",
      "ndc_label_name": "Acetyl Salicylic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779095604",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779292204",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779095607",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779095608",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000311",
      "ndc_label_name": "Acetyl-D-Glucosamine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452010201",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452010202",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779292208",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779095605",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779292205",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552095104",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779292203",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991116901",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452010204",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452010205",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779292209",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779095609",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552095105",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000325",
      "ndc_label_name": "Acetyl-D-Glucosamine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552095102",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991116906",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000322",
      "ndc_label_name": "Acetyl-D-Glucosamine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779292207",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452010203",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552095106",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000301",
      "ndc_label_name": "Acetyl-D-Glucosamine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000305",
      "ndc_label_name": "Acetyl-D-Glucosamine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991116903",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991116902",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927257300",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991116907",
      "ndc_label_name": "Acetyl-D-Glucosamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000310",
      "ndc_label_name": "Acetyl-D-Glucosamine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991163702",
      "ndc_label_name": "Acetyl-L-Carnitine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927261100",
      "ndc_label_name": "Acetyl-L-Carnitine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779095805",
      "ndc_label_name": "Acetyl-L-Carnitine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779095804",
      "ndc_label_name": "Acetyl-L-Carnitine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991163703",
      "ndc_label_name": "Acetyl-L-Carnitine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552099407",
      "ndc_label_name": "Acetyl-L-Carnitine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779095809",
      "ndc_label_name": "Acetyl-L-Carnitine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991163701",
      "ndc_label_name": "Acetyl-L-Carnitine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927232600",
      "ndc_label_name": "Acetylcholine Chloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779270004",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779270008",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779270005",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779049507",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779049504",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779049509",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779049505",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452009702",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452009701",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452009704",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452009703",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779049508",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779270009",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452009801",
      "ndc_label_name": "Acetylcysteine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452009803",
      "ndc_label_name": "Acetylcysteine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452009802",
      "ndc_label_name": "Acetylcysteine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927160100",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552020105",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452009804",
      "ndc_label_name": "Acetylcysteine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552020104",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452009805",
      "ndc_label_name": "Acetylcysteine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991100302",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552020107",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991100301",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991100303",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991100304",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991100307",
      "ndc_label_name": "Acetylcysteine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42494043525",
      "ndc_label_name": "Acetylcysteine Solution 10 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517750401",
      "ndc_label_name": "Acetylcysteine Solution 10 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517750425",
      "ndc_label_name": "Acetylcysteine SOLUTION 10 % INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517751003",
      "ndc_label_name": "Acetylcysteine SOLUTION 10 % INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069001801",
      "ndc_label_name": "Acetylcysteine Solution 10 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409330711",
      "ndc_label_name": "Acetylcysteine Solution 10 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409330703",
      "ndc_label_name": "Acetylcysteine SOLUTION 10 % INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069322",
      "ndc_label_name": "Acetylcysteine Solution 10 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069122",
      "ndc_label_name": "Acetylcysteine Solution 10 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069310",
      "ndc_label_name": "Acetylcysteine SOLUTION 10 % INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069504",
      "ndc_label_name": "Acetylcysteine SOLUTION 10 % INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069130",
      "ndc_label_name": "Acetylcysteine SOLUTION 10 % INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069522",
      "ndc_label_name": "Acetylcysteine Solution 10 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069001825",
      "ndc_label_name": "Acetylcysteine Solution 10 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069001901",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069022",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517760425",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409330803",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517761003",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069041",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517760401",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42494043625",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069222",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069030",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069002003",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409330811",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069404",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069044",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069422",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069002001",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069444",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069210",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323069441",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069001925",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574080530",
      "ndc_label_name": "Acetylcysteine SOLUTION 200 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462094612",
      "ndc_label_name": "Acetylcysteine Solution 200 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150025930",
      "ndc_label_name": "Acetylcysteine SOLUTION 200 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021081266",
      "ndc_label_name": "Acetylcysteine Solution 200 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323096321",
      "ndc_label_name": "Acetylcysteine Solution 200 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478066030",
      "ndc_label_name": "Acetylcysteine Solution 200 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069078801",
      "ndc_label_name": "Acetylcysteine Solution 200 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021081230",
      "ndc_label_name": "Acetylcysteine Solution 200 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323096341",
      "ndc_label_name": "Acetylcysteine Solution 200 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594011102",
      "ndc_label_name": "Acetylcysteine Solution 200 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594011101",
      "ndc_label_name": "Acetylcysteine Solution 200 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462094630",
      "ndc_label_name": "Acetylcysteine Solution 200 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611086001",
      "ndc_label_name": "Acetylcysteine Solution 200 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323096344",
      "ndc_label_name": "Acetylcysteine Solution 200 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323096330",
      "ndc_label_name": "Acetylcysteine SOLUTION 200 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611086004",
      "ndc_label_name": "Acetylcysteine Solution 200 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069078804",
      "ndc_label_name": "Acetylcysteine Solution 200 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991200101",
      "ndc_label_name": "Acidophilus Lactobacillus POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779242705",
      "ndc_label_name": "Acidophilus Lactobacillus POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779242703",
      "ndc_label_name": "Acidophilus Lactobacillus POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779242708",
      "ndc_label_name": "Acidophilus Lactobacillus POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991200104",
      "ndc_label_name": "Acidophilus Lactobacillus POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991200102",
      "ndc_label_name": "Acidophilus Lactobacillus POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779242709",
      "ndc_label_name": "Acidophilus Lactobacillus POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927424400",
      "ndc_label_name": "Acidophilus Lactobacillus POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991200103",
      "ndc_label_name": "Acidophilus Lactobacillus POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991313704",
      "ndc_label_name": "Acidophilus Lactobacillus Powder 10 BIL UNT/GM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991313702",
      "ndc_label_name": "Acidophilus Lactobacillus Powder 10 BIL UNT/GM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991313703",
      "ndc_label_name": "Acidophilus Lactobacillus Powder 10 BIL UNT/GM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991313701",
      "ndc_label_name": "Acidophilus Lactobacillus Powder 10 BIL UNT/GM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927352200",
      "ndc_label_name": "Acidophilus Lactobacillus Powder 10 BIL UNT/GM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332074130",
      "ndc_label_name": "Acitretin Capsule 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093113556",
      "ndc_label_name": "Acitretin CAPSULE 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378702093",
      "ndc_label_name": "Acitretin CAPSULE 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162222203",
      "ndc_label_name": "Acitretin Capsule 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115175008",
      "ndc_label_name": "Acitretin CAPSULE 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794008008",
      "ndc_label_name": "Acitretin CAPSULE 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008630",
      "ndc_label_name": "Acitretin CAPSULE 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115175108",
      "ndc_label_name": "Acitretin Capsule 17.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008730",
      "ndc_label_name": "Acitretin CAPSULE 17.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794008108",
      "ndc_label_name": "Acitretin CAPSULE 17.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162222403",
      "ndc_label_name": "Acitretin Capsule 17.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093113856",
      "ndc_label_name": "Acitretin CAPSULE 17.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332074230",
      "ndc_label_name": "Acitretin Capsule 17.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162222303",
      "ndc_label_name": "Acitretin Capsule 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332074330",
      "ndc_label_name": "Acitretin Capsule 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115175308",
      "ndc_label_name": "Acitretin CAPSULE 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093113656",
      "ndc_label_name": "Acitretin CAPSULE 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378702393",
      "ndc_label_name": "Acitretin CAPSULE 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008830",
      "ndc_label_name": "Acitretin CAPSULE 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794008308",
      "ndc_label_name": "Acitretin CAPSULE 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63347092001",
      "ndc_label_name": "AcNesic Gel 0.5 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242014301",
      "ndc_label_name": "Actemra ACTPen Solution Auto-Injector 162 MG/0.9ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242013801",
      "ndc_label_name": "Actemra Solution Prefilled Syringe 162 MG/0.9ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63004871001",
      "ndc_label_name": "Acthar Gel 80 UNIT/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63004871201",
      "ndc_label_name": "Acthar Gel Auto-Injector 40 UNIT/0.5ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63004871101",
      "ndc_label_name": "Acthar Gel Auto-Injector 80 UNIT/ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63004871204",
      "ndc_label_name": "Acthar Gel Pen-Injector 40 UNIT/0.5ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63004871201",
      "ndc_label_name": "Acthar Gel Pen-Injector 40 UNIT/0.5ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63004871101",
      "ndc_label_name": "Acthar Gel Pen-Injector 80 UNIT/ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63004871104",
      "ndc_label_name": "Acthar Gel Pen-Injector 80 UNIT/ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281054758",
      "ndc_label_name": "ActHIB SOLUTION RECONSTITUTED Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281054503",
      "ndc_label_name": "ActHIB SOLUTION RECONSTITUTED Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16110050201",
      "ndc_label_name": "Acticlate Tablet 150 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16110050101",
      "ndc_label_name": "Acticlate Tablet 75 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75987011111",
      "ndc_label_name": "Actimmune Solution 100 MCG/0.5ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75987011110",
      "ndc_label_name": "Actimmune Solution 100 MCG/0.5ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927411800",
      "ndc_label_name": "Actiphyte of Algae GL Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927411700",
      "ndc_label_name": "Actiphyte of Cucumber Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927411900",
      "ndc_label_name": "Actiphyte of Ivy Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927411400",
      "ndc_label_name": "Actiphyte of Lemongrass Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927509400",
      "ndc_label_name": "Actiphyte of Sea Kelp Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927510300",
      "ndc_label_name": "Actiphyte of Sugar Kelp Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356046030",
      "ndc_label_name": "Actiq Lozenge On A Handle 1200 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459051230",
      "ndc_label_name": "Actiq Lozenge On A Handle 1200 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459051201",
      "ndc_label_name": "Actiq Lozenge On A Handle 1200 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459051601",
      "ndc_label_name": "Actiq Lozenge On A Handle 1600 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356046130",
      "ndc_label_name": "Actiq Lozenge On A Handle 1600 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459051630",
      "ndc_label_name": "Actiq Lozenge On A Handle 1600 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459050201",
      "ndc_label_name": "Actiq Lozenge On A Handle 200 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459050230",
      "ndc_label_name": "Actiq Lozenge On A Handle 200 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356045730",
      "ndc_label_name": "Actiq Lozenge On A Handle 400 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459050430",
      "ndc_label_name": "Actiq Lozenge On A Handle 400 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459050401",
      "ndc_label_name": "Actiq Lozenge On A Handle 400 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356045830",
      "ndc_label_name": "Actiq Lozenge On A Handle 600 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459050630",
      "ndc_label_name": "Actiq Lozenge On A Handle 600 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459050601",
      "ndc_label_name": "Actiq Lozenge On A Handle 600 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459050830",
      "ndc_label_name": "Actiq Lozenge On A Handle 800 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356045930",
      "ndc_label_name": "Actiq Lozenge On A Handle 800 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459050801",
      "ndc_label_name": "Actiq Lozenge On A Handle 800 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242008527",
      "ndc_label_name": "Activase SOLUTION RECONSTITUTED 100 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242004413",
      "ndc_label_name": "Activase SOLUTION RECONSTITUTED 50 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60846023201",
      "ndc_label_name": "Activella Tablet 1-0.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00430047801",
      "ndc_label_name": "Actonel TABLET 150 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00430047802",
      "ndc_label_name": "Actonel Tablet 150 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00430047207",
      "ndc_label_name": "Actonel Tablet 35 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00430047203",
      "ndc_label_name": "Actonel TABLET 35 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64764015860",
      "ndc_label_name": "Actoplus Met TABLET 15-850 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071040515",
      "ndc_label_name": "Actos TABLET 15 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105015615",
      "ndc_label_name": "Actos TABLET 15 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105015606",
      "ndc_label_name": "Actos TABLET 15 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999044915",
      "ndc_label_name": "Actos Tablet 15 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105015609",
      "ndc_label_name": "Actos TABLET 15 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64764015104",
      "ndc_label_name": "Actos TABLET 15 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105015603",
      "ndc_label_name": "Actos TABLET 15 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105015601",
      "ndc_label_name": "Actos TABLET 15 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64764030114",
      "ndc_label_name": "Actos TABLET 30 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071040615",
      "ndc_label_name": "Actos TABLET 30 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071040715",
      "ndc_label_name": "Actos TABLET 45 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64764045124",
      "ndc_label_name": "Actos TABLET 45 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023927705",
      "ndc_label_name": "Acular LS SOLUTION 0.4 % OPHTHALMIC",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999069505",
      "ndc_label_name": "Acular Solution 0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023218105",
      "ndc_label_name": "Acular SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959011405",
      "ndc_label_name": "Acular Solution 0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61480013705",
      "ndc_label_name": "Acunol TABLET ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023350730",
      "ndc_label_name": "Acuvail Solution 0.45 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023350731",
      "ndc_label_name": "Acuvail Solution 0.45 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71300670403",
      "ndc_label_name": "Acyclonine MUM Aerosol Powder 36.7-16.7-3.33 % Mouth/Throat",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703081",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603005",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603060",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703030",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603081",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291001750",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904751961",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603001",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090059500",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082650",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090573901",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703083",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703060",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999038525",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155022901",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082605",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090561001",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999038515",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090721600",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703085",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291001701",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090573900",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999038540",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090561007",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407085205",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090059501",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051750",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904578961",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999038510",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002024530",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090059600",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090573907",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205020950",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090561000",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760060660",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155022905",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090059601",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002024550",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090721601",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051730",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335028000",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002024535",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000625",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090059507",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407085201",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011401",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090721607",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051735",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335028003",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187018290",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084010711",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090059607",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002024525",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135003950",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002024560",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429001201",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335028005",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518249600",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69076014601",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051725",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429001205",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304065205",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000650",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205024390",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162170402",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047007",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205057830",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348062025",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505004206",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000640",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084010701",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335028001",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162190806",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047008",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335028002",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700065130",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011405",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047003",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518249601",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335028006",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834012401",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162170405",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335028004",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047000",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919033130",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047004",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047006",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335028008",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304065201",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162190807",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335028007",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047009",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629200901",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162170409",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162170401",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047005",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205020990",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162190808",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335028009",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162170400",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205057890",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162190805",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162170404",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162190803",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047001",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81288003902",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162170403",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162170406",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047002",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162190804",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162190800",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578000201",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921014601",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789053650",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162190809",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81288003901",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162170407",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578000205",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162170408",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162190801",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162190802",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72241002805",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804024590",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162232702",
      "ndc_label_name": "Acyclovir Cream 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332042305",
      "ndc_label_name": "Acyclovir Cream 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093363020",
      "ndc_label_name": "Acyclovir Cream 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802004475",
      "ndc_label_name": "Acyclovir Cream 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162083614",
      "ndc_label_name": "Acyclovir Cream 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578010105",
      "ndc_label_name": "Acyclovir Cream 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672136105",
      "ndc_label_name": "Acyclovir Cream 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378870049",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168082515",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378870006",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168082530",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714088502",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668051502",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578008206",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591115930",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342043915",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672136001",
      "ndc_label_name": "Acyclovir OINTMENT 5 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668051501",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342043930",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332024830",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714088501",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090656100",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162083596",
      "ndc_label_name": "Acyclovir OINTMENT 5 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079055067",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332024815",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462074617",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629232701",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63646030015",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079055068",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382099201",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578008201",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462074635",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63646030030",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700010715",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629232801",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672136002",
      "ndc_label_name": "Acyclovir OINTMENT 5 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700010716",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332024805",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162196002",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162083594",
      "ndc_label_name": "Acyclovir OINTMENT 5 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382099204",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788824701",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162196003",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991100401",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000103",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000101",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779017301",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552067106",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779017304",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779017308",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000102",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991100404",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000106",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000104",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000105",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000611",
      "ndc_label_name": "Acyclovir Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779017305",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552067103",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000605",
      "ndc_label_name": "Acyclovir Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998003",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000601",
      "ndc_label_name": "Acyclovir Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000107",
      "ndc_label_name": "Acyclovir Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000108",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998001",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552067101",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552067105",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000610",
      "ndc_label_name": "Acyclovir Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998004",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991100402",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927299400",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552067102",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998006",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552067104",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000625",
      "ndc_label_name": "Acyclovir Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307001611",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307001615",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457989303",
      "ndc_label_name": "Acyclovir Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991100403",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307001639",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457989304",
      "ndc_label_name": "Acyclovir Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998005",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991100405",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998002",
      "ndc_label_name": "Acyclovir POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032524",
      "ndc_label_name": "Acyclovir Sodium SOLUTION 50 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150015521",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150015520",
      "ndc_label_name": "Acyclovir Sodium SOLUTION 50 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219062202",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382004910",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150015410",
      "ndc_label_name": "Acyclovir Sodium SOLUTION 50 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032509",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150015411",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032510",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382004901",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219062420",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032514",
      "ndc_label_name": "Acyclovir Sodium SOLUTION 50 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382004801",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032503",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436003082",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032520",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382004810",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219062210",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219062404",
      "ndc_label_name": "Acyclovir Sodium Solution 50 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135080347",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689034216",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472008216",
      "ndc_label_name": "Acyclovir SUSPENSION 200 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205017072",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954018810",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378871273",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155048551",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722068147",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383081016",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651049347",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135080305",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135080324",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888007917",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135080323",
      "ndc_label_name": "Acyclovir Suspension 800 MG/20ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135080320",
      "ndc_label_name": "Acyclovir Suspension 800 MG/20ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603105",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703185",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703130",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064206",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999008625",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603130",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603101",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603181",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603125",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063034025",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703181",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090156703",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064202",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904579061",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722077701",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904750761",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703125",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092815",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155022701",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090325005",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064203",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722077705",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063034005",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155022705",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063034001",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092860",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356090340",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090325400",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090156702",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063034004",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063034040",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092805",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063034015",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064204",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092825",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090727504",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090325003",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063034030",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064403",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999008600",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092804",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064205",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064404",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006115",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090325004",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063034060",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090156705",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999008690",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064300",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064301",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064409",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054415",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090684400",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092830",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090325009",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064405",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064402",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090325002",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090727601",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505530601",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090727505",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063092840",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090325401",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064406",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090156704",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090727600",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407014501",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505530608",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006111",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999008621",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090727503",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064500",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090156709",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090727700",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054412",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919065414",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407014505",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064209",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002000815",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054401",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090727506",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348062710",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054425",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757605",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054430",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090064501",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757603",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054421",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090727509",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348062715",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700053935",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757606",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348062730",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090156706",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820301",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002000830",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054410",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687085601",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687085611",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757608",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011205",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090325006",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820308",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700053940",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054450",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000725",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687085665",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776003",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919037014",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090727502",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788872403",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304050401",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000721",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757609",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011201",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934013130",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919065430",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054440",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518211702",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084010811",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382079105",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776002",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919037030",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934051230",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187025315",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054460",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934055760",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382079101",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776009",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776004",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084010801",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934051245",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267000715",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002000821",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032301",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776005",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820302",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776007",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776001",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934069460",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757601",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002000860",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032303",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820303",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820305",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518133202",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776006",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032304",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757602",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187025330",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162173503",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788872401",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788872402",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934055715",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788776008",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162173504",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757604",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187025360",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425027001",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788872408",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788872405",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934055730",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820304",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162173505",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042703",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757607",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117001802",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367013705",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117001801",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032308",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452029020",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81288001801",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518211701",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788872404",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452029030",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518330600",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367013701",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335105308",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518245502",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81288001802",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518245501",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042700",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205037130",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205047215",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042701",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834012205",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032307",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804000530",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518245503",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042702",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335105304",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335105300",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205005630",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518211700",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335105306",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335105302",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934069490",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934069430",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189063114",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335105303",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205039125",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032302",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205047230",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162173501",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032309",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032305",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032300",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804000521",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335105301",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162173502",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335032306",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162173507",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834012201",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162173506",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722077801",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703381",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603320",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603301",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703310",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603305",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603381",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155022805",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090063702",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722077805",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063058910",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353093318",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002002735",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440603310",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703320",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063058930",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090633500",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063058935",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090063802",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090063700",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505530701",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063058950",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440703385",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090063703",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090633502",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090063800",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090633503",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090162402",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011301",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002002710",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155022801",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090657803",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090657800",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090657802",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067850",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505530705",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167805",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002002715",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090162400",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407014601",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006211",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006215",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187057435",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687086711",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167808",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002002720",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090162403",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067830",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002002750",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407014605",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629917401",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919053035",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267039935",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002002725",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067840",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167802",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687086701",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760077835",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267039930",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084010911",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084010901",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700083535",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002002730",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788737802",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135001950",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167807",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788789503",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788737806",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382079205",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442011305",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002002760",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757508",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167803",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788737805",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788843402",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788737807",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788737803",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919000335",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187057406",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788789505",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788843405",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757503",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205038830",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757506",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788737808",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919053030",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167801",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788792302",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117001901",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757505",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205038835",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335138106",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757502",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187057425",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167804",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788843403",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117001902",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788792305",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189023230",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335138109",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452029120",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304050501",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382079201",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788843404",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205005330",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367013805",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757504",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518251801",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452029130",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629917402",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757507",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335138104",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335138100",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335069502",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788789502",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335138107",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205005335",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788737804",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788792303",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189023235",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335138103",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335138102",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788792304",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81288001902",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335255503",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788789504",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788843408",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804001230",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162172407",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335138105",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367013801",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518251800",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162172400",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162172403",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335138101",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518333100",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162172409",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162172405",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335138108",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934055635",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162172402",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162172408",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162172401",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934082835",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81288001901",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335069508",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162172404",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834012301",
      "ndc_label_name": "Acyclovir TABLET 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162172406",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834012305",
      "ndc_label_name": "Acyclovir TABLET 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804001235",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779303109",
      "ndc_label_name": "ADA SHAMPOO EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779303108",
      "ndc_label_name": "ADA SHAMPOO EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281040058",
      "ndc_label_name": "Adacel SUSPENSION 5-2-15.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281040010",
      "ndc_label_name": "Adacel SUSPENSION 5-2-15.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090107900",
      "ndc_label_name": "Adacel Suspension 5-2-15.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281040089",
      "ndc_label_name": "Adacel Suspension Prefilled Syringe 5-2-15.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281040020",
      "ndc_label_name": "Adacel Suspension Prefilled Syringe 5-2-15.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72934133602",
      "ndc_label_name": "Adainzde Gel 0.3-2.5-1 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219061299",
      "ndc_label_name": "Adalimumab-aacf (2 Pen) Auto-Injector Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219062020",
      "ndc_label_name": "Adalimumab-aacf (2 Syringe) Prefilled Syringe Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219061289",
      "ndc_label_name": "Adalimumab-aacf(CD/UC/HS Strt) Auto-Injector Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219061269",
      "ndc_label_name": "Adalimumab-aacf(Ps/UV Starter) Auto-Injector Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72606002209",
      "ndc_label_name": "Adalimumab-aaty (1 Pen) Auto-Injector Kit 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72606004004",
      "ndc_label_name": "Adalimumab-aaty (1 Pen) Auto-Injector Kit 80 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72606002210",
      "ndc_label_name": "Adalimumab-aaty (2 Pen) Auto-Injector Kit 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72606004101",
      "ndc_label_name": "Adalimumab-aaty (2 Syringe) Prefilled Syringe Kit 20 MG/0.2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72606002206",
      "ndc_label_name": "Adalimumab-aaty (2 Syringe) Prefilled Syringe Kit 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72606004006",
      "ndc_label_name": "Adalimumab-aaty CD/UC/HS Start Auto-Injector Kit 80 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314032796",
      "ndc_label_name": "Adalimumab-adaz Solution Auto-Injector 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314032720",
      "ndc_label_name": "Adalimumab-adaz Solution Auto-Injector 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314032520",
      "ndc_label_name": "Adalimumab-adaz Solution Auto-Injector 80 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314039164",
      "ndc_label_name": "Adalimumab-adaz Solution Prefilled Syringe 10 MG/0.1ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314033294",
      "ndc_label_name": "Adalimumab-adaz Solution Prefilled Syringe 20 MG/0.2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314033264",
      "ndc_label_name": "Adalimumab-adaz Solution Prefilled Syringe 20 MG/0.2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314032764",
      "ndc_label_name": "Adalimumab-adaz Solution Prefilled Syringe 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314032794",
      "ndc_label_name": "Adalimumab-adaz Solution Prefilled Syringe 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00597057550",
      "ndc_label_name": "Adalimumab-adbm (2 Pen) Auto-Injector Kit 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009014422",
      "ndc_label_name": "Adalimumab-adbm (2 Pen) Auto-Injector Kit 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00597054522",
      "ndc_label_name": "Adalimumab-adbm (2 Pen) Auto-Injector Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009014822",
      "ndc_label_name": "Adalimumab-adbm (2 Pen) Auto-Injector Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00597058589",
      "ndc_label_name": "Adalimumab-adbm (2 Syringe) Prefilled Syringe Kit 10 MG/0.2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00597055580",
      "ndc_label_name": "Adalimumab-adbm (2 Syringe) Prefilled Syringe Kit 20 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009014622",
      "ndc_label_name": "Adalimumab-adbm (2 Syringe) Prefilled Syringe Kit 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00597056520",
      "ndc_label_name": "Adalimumab-adbm (2 Syringe) Prefilled Syringe Kit 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009015022",
      "ndc_label_name": "Adalimumab-adbm (2 Syringe) Prefilled Syringe Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00597059520",
      "ndc_label_name": "Adalimumab-adbm (2 Syringe) Prefilled Syringe Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00597057560",
      "ndc_label_name": "Adalimumab-adbm(CD/UC/HS Strt) Auto-Injector Kit 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00597054566",
      "ndc_label_name": "Adalimumab-adbm(CD/UC/HS Strt) Auto-Injector Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00597057540",
      "ndc_label_name": "Adalimumab-adbm(Ps/UV Starter) Auto-Injector Kit 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00597054544",
      "ndc_label_name": "Adalimumab-adbm(Ps/UV Starter) Auto-Injector Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49502041602",
      "ndc_label_name": "Adalimumab-fkjp (2 Pen) Auto-Injector Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83257002232",
      "ndc_label_name": "Adalimumab-fkjp (2 Pen) Auto-Injector Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49502041702",
      "ndc_label_name": "Adalimumab-fkjp (2 Syringe) Prefilled Syringe Kit 20 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83257002042",
      "ndc_label_name": "Adalimumab-fkjp (2 Syringe) Prefilled Syringe Kit 20 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49502041802",
      "ndc_label_name": "Adalimumab-fkjp (2 Syringe) Prefilled Syringe Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83257002142",
      "ndc_label_name": "Adalimumab-fkjp (2 Syringe) Prefilled Syringe Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49502041606",
      "ndc_label_name": "Adalimumab-fkjp Auto-Injector Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49502041706",
      "ndc_label_name": "Adalimumab-fkjp Prefilled Syringe Kit 20 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49502041806",
      "ndc_label_name": "Adalimumab-fkjp Prefilled Syringe Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51759036117",
      "ndc_label_name": "Adalimumab-ryvk (1 Pen) Auto-Injector Kit 80 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51759036002",
      "ndc_label_name": "Adalimumab-ryvk (2 Pen) Auto-Injector Kit 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009015622",
      "ndc_label_name": "Adalimumab-ryvk (2 Pen) Auto-Injector Kit 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009015822",
      "ndc_label_name": "Adalimumab-ryvk (2 Syringe) Prefilled Syringe Kit 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50222035001",
      "ndc_label_name": "Adbry Solution Auto-Injector 300 MG/2ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50222035002",
      "ndc_label_name": "Adbry Solution Auto-Injector 300 MG/2ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50222034602",
      "ndc_label_name": "Adbry Solution Prefilled Syringe 150 MG/ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50222034604",
      "ndc_label_name": "Adbry Solution Prefilled Syringe 150 MG/ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61269016750",
      "ndc_label_name": "ADC/F (0.5mg/ml) Solution 0.5 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353007004",
      "ndc_label_name": "Adcirca Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66302046760",
      "ndc_label_name": "Adcirca Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353007002",
      "ndc_label_name": "Adcirca Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353007012",
      "ndc_label_name": "Adcirca Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353007006",
      "ndc_label_name": "Adcirca Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57844011001",
      "ndc_label_name": "Adderall TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57844011201",
      "ndc_label_name": "Adderall TABLET 12.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57844011501",
      "ndc_label_name": "Adderall TABLET 15 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57844012001",
      "ndc_label_name": "Adderall TABLET 20 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57844013001",
      "ndc_label_name": "Adderall TABLET 30 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57844010501",
      "ndc_label_name": "Adderall TABLET 5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57844011701",
      "ndc_label_name": "Adderall TABLET 7.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54092038301",
      "ndc_label_name": "Adderall XR Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356014790",
      "ndc_label_name": "Adderall XR Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356014890",
      "ndc_label_name": "Adderall XR Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54092038501",
      "ndc_label_name": "Adderall XR CAPSULE EXTENDED RELEASE 24 HOUR 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54092038701",
      "ndc_label_name": "Adderall XR Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54092038901",
      "ndc_label_name": "Adderall XR Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54092039101",
      "ndc_label_name": "Adderall XR Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54092038101",
      "ndc_label_name": "Adderall XR Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42794000308",
      "ndc_label_name": "Adefovir Dipivoxil TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505394703",
      "ndc_label_name": "Adefovir Dipivoxil Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779290404",
      "ndc_label_name": "Ademetionine Disulf Tosylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779290403",
      "ndc_label_name": "Ademetionine Disulf Tosylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779290409",
      "ndc_label_name": "Ademetionine Disulf Tosylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779290405",
      "ndc_label_name": "Ademetionine Disulf Tosylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779290408",
      "ndc_label_name": "Ademetionine Disulf Tosylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927519400",
      "ndc_label_name": "Ademetionine Disulf Tosylate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419025001",
      "ndc_label_name": "Adempas TABLET 0.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419025091",
      "ndc_label_name": "Adempas TABLET 0.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419025191",
      "ndc_label_name": "Adempas TABLET 1 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419025101",
      "ndc_label_name": "Adempas TABLET 1 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419025291",
      "ndc_label_name": "Adempas TABLET 1.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419025201",
      "ndc_label_name": "Adempas TABLET 1.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419025391",
      "ndc_label_name": "Adempas TABLET 2 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419025301",
      "ndc_label_name": "Adempas TABLET 2 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419025401",
      "ndc_label_name": "Adempas TABLET 2.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419025491",
      "ndc_label_name": "Adempas TABLET 2.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092159350",
      "ndc_label_name": "Adenocaine Solution Prefilled Syringe Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552145604",
      "ndc_label_name": "Adenosine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452013101",
      "ndc_label_name": "Adenosine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452013002",
      "ndc_label_name": "Adenosine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452013102",
      "ndc_label_name": "Adenosine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452013001",
      "ndc_label_name": "Adenosine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452013104",
      "ndc_label_name": "Adenosine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452013103",
      "ndc_label_name": "Adenosine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927211600",
      "ndc_label_name": "Adenosine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552145603",
      "ndc_label_name": "Adenosine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552145605",
      "ndc_label_name": "Adenosine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552145606",
      "ndc_label_name": "Adenosine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927501200",
      "ndc_label_name": "Adenosine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927202700",
      "ndc_label_name": "Adenosine-5-Monophosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927213200",
      "ndc_label_name": "Adenosine-5-Triphosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72912052530",
      "ndc_label_name": "Adhansia XR Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72912053530",
      "ndc_label_name": "Adhansia XR Capsule Extended Release 24 Hour 35 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72912054530",
      "ndc_label_name": "Adhansia XR Capsule Extended Release 24 Hour 45 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72912055530",
      "ndc_label_name": "Adhansia XR Capsule Extended Release 24 Hour 55 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72912057030",
      "ndc_label_name": "Adhansia XR Capsule Extended Release 24 Hour 70 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72912058530",
      "ndc_label_name": "Adhansia XR Capsule Extended Release 24 Hour 85 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65038005603",
      "ndc_label_name": "Adlarity Patch Weekly 10 MG/DAY Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65038005601",
      "ndc_label_name": "Adlarity Patch Weekly 10 MG/DAY Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65038005503",
      "ndc_label_name": "Adlarity Patch Weekly 5 MG/DAY Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65038005501",
      "ndc_label_name": "Adlarity Patch Weekly 5 MG/DAY Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024592505",
      "ndc_label_name": "Admelog SoloStar Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024592501",
      "ndc_label_name": "Admelog SoloStar Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024592500",
      "ndc_label_name": "Admelog SoloStar Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024592410",
      "ndc_label_name": "Admelog Solution 100 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024592605",
      "ndc_label_name": "Admelog Solution 100 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927372200",
      "ndc_label_name": "Adrenal C Formula TABLET ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023015901",
      "ndc_label_name": "Adrenalin Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023015925",
      "ndc_label_name": "Adrenalin Solution 1 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023072101",
      "ndc_label_name": "Adrenalin Solution 10-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023072110",
      "ndc_label_name": "Adrenalin Solution 10-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023027310",
      "ndc_label_name": "Adrenalin Solution 2-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023027301",
      "ndc_label_name": "Adrenalin Solution 2-0.9 MG/250ML-% Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023016801",
      "ndc_label_name": "Adrenalin Solution 30 MG/30ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023016899",
      "ndc_label_name": "Adrenalin Solution 30 MG/30ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023016889",
      "ndc_label_name": "Adrenalin Solution 30 MG/30ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927285700",
      "ndc_label_name": "Adrenochrome Semicarbazone POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779190409",
      "ndc_label_name": "Adrenocorticotrophic Hormone POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779190400",
      "ndc_label_name": "Adrenocorticotrophic Hormone POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779190407",
      "ndc_label_name": "Adrenocorticotrophic Hormone POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17156023501",
      "ndc_label_name": "AdreView Solution 10 MCI/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24338000990",
      "ndc_label_name": "Adthyza Tablet 120 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24338011390",
      "ndc_label_name": "Adthyza Tablet 130 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24338000590",
      "ndc_label_name": "Adthyza Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24338001690",
      "ndc_label_name": "Adthyza Tablet 16.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24338000690",
      "ndc_label_name": "Adthyza Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24338003290",
      "ndc_label_name": "Adthyza Tablet 32.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24338000790",
      "ndc_label_name": "Adthyza Tablet 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24338006590",
      "ndc_label_name": "Adthyza Tablet 65 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24338000890",
      "ndc_label_name": "Adthyza Tablet 90 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24338009790",
      "ndc_label_name": "Adthyza Tablet 97.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090431000",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 100-50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173069504",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 100-50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261087301",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 100-50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173069500",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 100-50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090073000",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 100-50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569524100",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 100-50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518051400",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 100-50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173069600",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261087401",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173069604",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518053800",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569524200",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090073100",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090450200",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173069704",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 500-50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090450500",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 500-50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090073200",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 500-50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173069700",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 500-50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569524300",
      "ndc_label_name": "Advair Diskus Aerosol Powder Breath Activated 500-50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173071620",
      "ndc_label_name": "Advair HFA Aerosol 115-21 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090367200",
      "ndc_label_name": "Advair HFA Aerosol 115-21 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090450400",
      "ndc_label_name": "Advair HFA Aerosol 115-21 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173071622",
      "ndc_label_name": "Advair HFA Aerosol 115-21 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090450700",
      "ndc_label_name": "Advair HFA Aerosol 115-21 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173071722",
      "ndc_label_name": "Advair HFA Aerosol 230-21 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173071761",
      "ndc_label_name": "Advair HFA Aerosol 230-21 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173071720",
      "ndc_label_name": "Advair HFA Aerosol 230-21 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173071522",
      "ndc_label_name": "Advair HFA Aerosol 45-21 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173071520",
      "ndc_label_name": "Advair HFA Aerosol 45-21 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944305302",
      "ndc_label_name": "Advate Solution Reconstituted 1000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944305402",
      "ndc_label_name": "Advate Solution Reconstituted 1500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944304510",
      "ndc_label_name": "Advate Solution Reconstituted 2000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944305102",
      "ndc_label_name": "Advate Solution Reconstituted 250 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944304610",
      "ndc_label_name": "Advate Solution Reconstituted 3000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944304710",
      "ndc_label_name": "Advate Solution Reconstituted 4000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944305202",
      "ndc_label_name": "Advate Solution Reconstituted 500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944462401",
      "ndc_label_name": "Adynovate SOLUTION RECONSTITUTED 1000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944462702",
      "ndc_label_name": "Adynovate SOLUTION RECONSTITUTED 1500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944462701",
      "ndc_label_name": "Adynovate SOLUTION RECONSTITUTED 1500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944462501",
      "ndc_label_name": "Adynovate SOLUTION RECONSTITUTED 2000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944462201",
      "ndc_label_name": "Adynovate SOLUTION RECONSTITUTED 250 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944462801",
      "ndc_label_name": "Adynovate SOLUTION RECONSTITUTED 3000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944462802",
      "ndc_label_name": "Adynovate SOLUTION RECONSTITUTED 3000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944462301",
      "ndc_label_name": "Adynovate SOLUTION RECONSTITUTED 500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944462602",
      "ndc_label_name": "Adynovate SOLUTION RECONSTITUTED 750 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944462601",
      "ndc_label_name": "Adynovate SOLUTION RECONSTITUTED 750 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70165002030",
      "ndc_label_name": "Adzenys XR-ODT Tablet Extended Release Dispersible 12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70165002530",
      "ndc_label_name": "Adzenys XR-ODT Tablet Extended Release Dispersible 15.7 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70165003030",
      "ndc_label_name": "Adzenys XR-ODT Tablet Extended Release Dispersible 18.8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70165000530",
      "ndc_label_name": "Adzenys XR-ODT Tablet Extended Release Dispersible 3.1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70165001030",
      "ndc_label_name": "Adzenys XR-ODT Tablet Extended Release Dispersible 6.3 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70165001530",
      "ndc_label_name": "Adzenys XR-ODT Tablet Extended Release Dispersible 9.4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57841120001",
      "ndc_label_name": "Aemcolo Tablet Delayed Release 194 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351050512",
      "ndc_label_name": "Aerobika Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351062510",
      "ndc_label_name": "Aerobika DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351098550",
      "ndc_label_name": "AeroChamber Holding Chamber Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351098810",
      "ndc_label_name": "AeroChamber Mini Chamber DEVICE",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351098510",
      "ndc_label_name": "AeroChamber MV",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351050012",
      "ndc_label_name": "AeroChamber Pls FloVu Mthpiece Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456315467",
      "ndc_label_name": "AeroChamber Plus Flo-Vu",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090034800",
      "ndc_label_name": "AeroChamber Plus Flo-Vu",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351050412",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Interm Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351088910",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Interm Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351080810",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Large",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456074613",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Large",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351050312",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Large Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351078810",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Medium",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351050212",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Medium Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456074413",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Small",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351088810",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Small",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351050112",
      "ndc_label_name": "AeroChamber Plus Flo-Vu Small Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351079810",
      "ndc_label_name": "AeroChamber Plus Flow VU",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351079850",
      "ndc_label_name": "AeroChamber Plus Flow VU",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351079510",
      "ndc_label_name": "AeroChamber w/FLOWSIGnal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351079710",
      "ndc_label_name": "AeroChamber Z-Stat Plus",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351079750",
      "ndc_label_name": "AeroChamber Z-Stat Plus Chambr",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351080710",
      "ndc_label_name": "AeroChamber Z-Stat Plus/Large",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351078710",
      "ndc_label_name": "AeroChamber Z-Stat Plus/Medium",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351088710",
      "ndc_label_name": "AeroChamber Z-Stat Plus/Small",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351050612",
      "ndc_label_name": "Aerochamber2GO Anti-Static Device",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351089510",
      "ndc_label_name": "Aerogear Action Asthma Kit Kit",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351052510",
      "ndc_label_name": "AeroTrach Plus",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078062651",
      "ndc_label_name": "Afinitor Disperz Tablet Soluble 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078062661",
      "ndc_label_name": "Afinitor Disperz Tablet Soluble 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078062751",
      "ndc_label_name": "Afinitor Disperz Tablet Soluble 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078062761",
      "ndc_label_name": "Afinitor Disperz Tablet Soluble 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078062851",
      "ndc_label_name": "Afinitor Disperz Tablet Soluble 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078062861",
      "ndc_label_name": "Afinitor Disperz Tablet Soluble 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078056761",
      "ndc_label_name": "Afinitor Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078056751",
      "ndc_label_name": "Afinitor Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078059461",
      "ndc_label_name": "Afinitor Tablet 2.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078059451",
      "ndc_label_name": "Afinitor Tablet 2.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078056651",
      "ndc_label_name": "Afinitor Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078056661",
      "ndc_label_name": "Afinitor Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078062061",
      "ndc_label_name": "Afinitor Tablet 7.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078062051",
      "ndc_label_name": "Afinitor Tablet 7.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862084988",
      "ndc_label_name": "Afirmelle Tablet 0.1-20 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862084928",
      "ndc_label_name": "Afirmelle Tablet 0.1-20 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332002404",
      "ndc_label_name": "Afluria Preservative Free Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332002503",
      "ndc_label_name": "Afluria Preservative Free Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332002403",
      "ndc_label_name": "Afluria Preservative Free Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332002504",
      "ndc_label_name": "Afluria Preservative Free Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332042210",
      "ndc_label_name": "Afluria Quadrivalent Suspension Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332042111",
      "ndc_label_name": "Afluria Quadrivalent Suspension Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332042110",
      "ndc_label_name": "Afluria Quadrivalent Suspension Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332042310",
      "ndc_label_name": "Afluria Quadrivalent Suspension Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332042311",
      "ndc_label_name": "Afluria Quadrivalent Suspension Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332042211",
      "ndc_label_name": "Afluria Quadrivalent Suspension Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332022120",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.25 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332022121",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.25 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332032102",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332032203",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332032101",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332032303",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332032204",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332032304",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332012410",
      "ndc_label_name": "Afluria Suspension Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332012511",
      "ndc_label_name": "Afluria Suspension Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332012411",
      "ndc_label_name": "Afluria Suspension Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332012510",
      "ndc_label_name": "Afluria Suspension Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47918089190",
      "ndc_label_name": "Afrezza POWDER 12 UNIT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47918090218",
      "ndc_label_name": "Afrezza Powder 60x4 &60x8 & 60x12 UNIT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47918087890",
      "ndc_label_name": "Afrezza POWDER 8 UNIT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47918089818",
      "ndc_label_name": "Afrezza Powder 90 x 8 UNIT & 90x12 UNIT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69911047602",
      "ndc_label_name": "Afstyla KIT 1000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69911048002",
      "ndc_label_name": "Afstyla KIT 1500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69911047702",
      "ndc_label_name": "Afstyla KIT 2000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69911047402",
      "ndc_label_name": "Afstyla KIT 250 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69911049101",
      "ndc_label_name": "Afstyla Kit 2500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69911048102",
      "ndc_label_name": "Afstyla KIT 2500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69911047802",
      "ndc_label_name": "Afstyla KIT 3000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69911047502",
      "ndc_label_name": "Afstyla KIT 500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69616026438",
      "ndc_label_name": "Agamree Suspension 40 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49452017001",
      "ndc_label_name": "Agar GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452017003",
      "ndc_label_name": "Agar GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452017002",
      "ndc_label_name": "Agar GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452018002",
      "ndc_label_name": "Agar POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452018001",
      "ndc_label_name": "Agar POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452018003",
      "ndc_label_name": "Agar POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54092006301",
      "ndc_label_name": "Agrylin Capsule 0.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513084301",
      "ndc_label_name": "Aimovig Solution Auto-Injector 140 MG/ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513084300",
      "ndc_label_name": "Aimovig Solution Auto-Injector 140 MG/ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513084101",
      "ndc_label_name": "Aimovig Solution Auto-Injector 70 MG/ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23359010190",
      "ndc_label_name": "Airavite Tablet 2.5-25-1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59310012906",
      "ndc_label_name": "AirDuo Digihaler Aerosol Powder Breath Activated 113-14 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59310013606",
      "ndc_label_name": "AirDuo Digihaler Aerosol Powder Breath Activated 232-14 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59310011106",
      "ndc_label_name": "AirDuo Digihaler Aerosol Powder Breath Activated 55-14 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59310081206",
      "ndc_label_name": "AirDuo RespiClick 113/14 Aerosol Powder Breath Activated 113-14 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59310082206",
      "ndc_label_name": "AirDuo RespiClick 232/14 Aerosol Powder Breath Activated 232-14 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59310080506",
      "ndc_label_name": "AirDuo RespiClick 55/14 Aerosol Powder Breath Activated 55-14 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59310080508",
      "ndc_label_name": "AirDuo RespiClick 55/14 Aerosol Powder Breath Activated 55-14 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00310908012",
      "ndc_label_name": "Airsupra Aerosol 90-80 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310908028",
      "ndc_label_name": "Airsupra Aerosol 90-80 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51759020210",
      "ndc_label_name": "Ajovy Solution Auto-Injector 225 MG/1.5ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51759020222",
      "ndc_label_name": "Ajovy Solution Auto-Injector 225 MG/1.5ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51759020211",
      "ndc_label_name": "Ajovy Solution Auto-Injector 225 MG/1.5ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51759020410",
      "ndc_label_name": "Ajovy Solution Prefilled Syringe 225 MG/1.5ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478023835",
      "ndc_label_name": "AK-Poly-Bac Ointment 500-10000 UNIT/GM Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57894010060",
      "ndc_label_name": "Akeega Tablet 100-500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57894005060",
      "ndc_label_name": "Akeega Tablet 50-500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478079201",
      "ndc_label_name": "Akten Gel 3.5 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82584079225",
      "ndc_label_name": "Akten Gel 3.5 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478079225",
      "ndc_label_name": "Akten Gel 3.5 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82584079201",
      "ndc_label_name": "Akten Gel 3.5 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69639010101",
      "ndc_label_name": "Akynzeo CAPSULE 300-0.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69639010201",
      "ndc_label_name": "Akynzeo Solution Reconstituted 235-0.25 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927257900",
      "ndc_label_name": "Alanine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927152300",
      "ndc_label_name": "Alaskan Red Algae POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052013410",
      "ndc_label_name": "Albendazole Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000210",
      "ndc_label_name": "Albendazole Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927176300",
      "ndc_label_name": "Albendazole POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000201",
      "ndc_label_name": "Albendazole Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000261",
      "ndc_label_name": "Albendazole Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000301",
      "ndc_label_name": "Albendazole POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000211",
      "ndc_label_name": "Albendazole Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000302",
      "ndc_label_name": "Albendazole POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052013401",
      "ndc_label_name": "Albendazole Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000303",
      "ndc_label_name": "Albendazole POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000305",
      "ndc_label_name": "Albendazole POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052013405",
      "ndc_label_name": "Albendazole Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162235902",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629927801",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714090702",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407025802",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591271202",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714090701",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722093502",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291009302",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097023772",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598045202",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710102106",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629122101",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205005108",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "78482011002",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799011002",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710102108",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162130904",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125079210",
      "ndc_label_name": "Albuked 25 Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090632000",
      "ndc_label_name": "Albuked 25 Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125079225",
      "ndc_label_name": "Albuked 25 Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125079211",
      "ndc_label_name": "Albuked 25 Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76125079226",
      "ndc_label_name": "Albuked 25 Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982064301",
      "ndc_label_name": "Albumin Human Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982064302",
      "ndc_label_name": "Albumin Human Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982062301",
      "ndc_label_name": "Albumin Human Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982062303",
      "ndc_label_name": "Albumin Human Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982062302",
      "ndc_label_name": "Albumin Human Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63546025105",
      "ndc_label_name": "Albumin-ZLB Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63546025110",
      "ndc_label_name": "Albumin-ZLB Solution 25 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63546031025",
      "ndc_label_name": "Albumin-ZLB Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63546031050",
      "ndc_label_name": "Albumin-ZLB Solution 5 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208251208",
      "ndc_label_name": "Albuminex Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208251204",
      "ndc_label_name": "Albuminex Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208251203",
      "ndc_label_name": "Albuminex Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208251207",
      "ndc_label_name": "Albuminex Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208251001",
      "ndc_label_name": "Albuminex Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208251005",
      "ndc_label_name": "Albuminex Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208251002",
      "ndc_label_name": "Albuminex Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64208251006",
      "ndc_label_name": "Albuminex Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206025110",
      "ndc_label_name": "AlbuRx Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206025191",
      "ndc_label_name": "AlbuRx Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206025190",
      "ndc_label_name": "AlbuRx Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206025105",
      "ndc_label_name": "AlbuRx Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206031025",
      "ndc_label_name": "AlbuRx Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206031090",
      "ndc_label_name": "AlbuRx Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206031050",
      "ndc_label_name": "AlbuRx Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206031091",
      "ndc_label_name": "AlbuRx Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521607",
      "ndc_label_name": "Albutein Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521601",
      "ndc_label_name": "Albutein Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521609",
      "ndc_label_name": "Albutein Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521606",
      "ndc_label_name": "Albutein Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521608",
      "ndc_label_name": "Albutein Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521602",
      "ndc_label_name": "Albutein Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521600",
      "ndc_label_name": "Albutein Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521603",
      "ndc_label_name": "Albutein Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521605",
      "ndc_label_name": "Albutein Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521604",
      "ndc_label_name": "Albutein Solution 25 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521404",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521405",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521403",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521402",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521407",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521401",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521409",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521400",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521406",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521408",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521804",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516521902",
      "ndc_label_name": "Albutein Solution 5 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090413801",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17270074000",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090413800",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054074287",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781729685",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093317431",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090517901",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00254100752",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090517900",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802008801",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180096301",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700090867",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788404102",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993001968",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090573501",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090413700",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629846801",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090523100",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572001401",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687066291",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788788102",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804003667",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788887402",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090414301",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518354100",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788735302",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097014260",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788878702",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788887802",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788799602",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205021185",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090573500",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205073285",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162121202",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282067942",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518285400",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420008801",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788747702",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420053101",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804018967",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425026601",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008007985",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425035901",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378827091",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090051601",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378827031",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378827052",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487950125",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487950103",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378827055",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335070349",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487950101",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090656000",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781715586",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090051600",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487950160",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335070352",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378827093",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204020025",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781715529",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154435905",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999034425",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788839902",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090340000",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687039583",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781715564",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788849202",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335070354",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135082884",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687039579",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204020030",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090656001",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862085825",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518261300",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204020060",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204020001",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862085830",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788770202",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862085860",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518241300",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383074120",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (5 MG/ML) 0.5% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980064203",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (5 MG/ML) 0.5% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73177016333",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (5 MG/ML) 0.5% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959074120",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (5 MG/ML) 0.5% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135082984",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (5 MG/ML) 0.5% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090051700",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (5 MG/ML) 0.5% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374033005",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (5 MG/ML) 0.5% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204002701",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (5 MG/ML) 0.5% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374030920",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (5 MG/ML) 0.5% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73177016332",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (5 MG/ML) 0.5% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204002711",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (5 MG/ML) 0.5% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73177014632",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (5 MG/ML) 0.5% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65302052815",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (5 MG/ML) 0.5% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73177014633",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (5 MG/ML) 0.5% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81483004400",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (5 MG/ML) 0.5% Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204001001",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651018325",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742039205",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378705752",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378705798",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591346753",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378699152",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378699198",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651018330",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487030101",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION 0.63 MG/3ML INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135082684",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742039225",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204001055",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378705852",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204001101",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378705898",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378699252",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591346853",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742039325",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378699298",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204001155",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135082784",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651018430",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487990401",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION 1.25 MG/3ML INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742039305",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487990425",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION 1.25 MG/3ML INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651018425",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487990130",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 2.5 MG/0.5ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452022604",
      "ndc_label_name": "Albuterol Sulfate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452226005",
      "ndc_label_name": "Albuterol Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452022601",
      "ndc_label_name": "Albuterol Sulfate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927157300",
      "ndc_label_name": "Albuterol Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452022602",
      "ndc_label_name": "Albuterol Sulfate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452226003",
      "ndc_label_name": "Albuterol Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452022605",
      "ndc_label_name": "Albuterol Sulfate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452022603",
      "ndc_label_name": "Albuterol Sulfate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452226001",
      "ndc_label_name": "Albuterol Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452226002",
      "ndc_label_name": "Albuterol Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452226004",
      "ndc_label_name": "Albuterol Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472082516",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959015303",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135018924",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383074016",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135018941",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135018905",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70752010212",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335290701",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135018947",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959015306",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162206402",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959015309",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135018920",
      "ndc_label_name": "Albuterol Sulfate Syrup 8 MG/20ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135018923",
      "ndc_label_name": "Albuterol Sulfate Syrup 8 MG/20ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440704530",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079065720",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407036701",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999090102",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289036330",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378025501",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440704524",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084094995",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629263801",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489017605",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289036324",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135067190",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980044201",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089811",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079065701",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001030",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543029010",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710106101",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489017601",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084094925",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089830",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089890",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289036320",
      "ndc_label_name": "Albuterol Sulfate TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238134401",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089860",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834027301",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629263802",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089800",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089855",
      "ndc_label_name": "Albuterol Sulfate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980044301",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489017705",
      "ndc_label_name": "Albuterol Sulfate TABLET 4 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289004530",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407036801",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378057201",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440704630",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959090620",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489017701",
      "ndc_label_name": "Albuterol Sulfate TABLET 4 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089911",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710106201",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089930",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135067290",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238134501",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084095295",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543029110",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089900",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084095225",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089955",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089960",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205089990",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834027401",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00998001615",
      "ndc_label_name": "Alcaine Solution 0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999035315",
      "ndc_label_name": "Alcaine Solution 0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026360",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672130606",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026315",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672130601",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672130603",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462030047",
      "ndc_label_name": "Alclometasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026345",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462030017",
      "ndc_label_name": "Alclometasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462030065",
      "ndc_label_name": "Alclometasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462029917",
      "ndc_label_name": "Alclometasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026415",
      "ndc_label_name": "Alclometasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672131601",
      "ndc_label_name": "Alclometasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026460",
      "ndc_label_name": "Alclometasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462029965",
      "ndc_label_name": "Alclometasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672131603",
      "ndc_label_name": "Alclometasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026445",
      "ndc_label_name": "Alclometasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672131606",
      "ndc_label_name": "Alclometasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462029947",
      "ndc_label_name": "Alclometasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452023002",
      "ndc_label_name": "Alcohol Anhydrous Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452023004",
      "ndc_label_name": "Alcohol Anhydrous Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452023001",
      "ndc_label_name": "Alcohol Anhydrous Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452284003",
      "ndc_label_name": "Alcohol, USP SOLUTION 95 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452284002",
      "ndc_label_name": "Alcohol, USP SOLUTION 95 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452284001",
      "ndc_label_name": "Alcohol, USP SOLUTION 95 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452284006",
      "ndc_label_name": "Alcohol, USP Solution 95 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025103131",
      "ndc_label_name": "Aldactone TABLET 100 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025100131",
      "ndc_label_name": "Aldactone TABLET 25 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025104131",
      "ndc_label_name": "Aldactone TABLET 50 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144010725",
      "ndc_label_name": "Aldosterone POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927209200",
      "ndc_label_name": "Aldosterone POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242013001",
      "ndc_label_name": "Alecensa Capsule 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054028259",
      "ndc_label_name": "Alendronate Sodium Solution 70 MG/75ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224030110",
      "ndc_label_name": "Alendronate Sodium Solution 70 MG/75ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954026410",
      "ndc_label_name": "Alendronate Sodium Solution 70 MG/75ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714063102",
      "ndc_label_name": "Alendronate Sodium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111058801",
      "ndc_label_name": "Alendronate Sodium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714063101",
      "ndc_label_name": "Alendronate Sodium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980034001",
      "ndc_label_name": "Alendronate Sodium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111058830",
      "ndc_label_name": "Alendronate Sodium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862032730",
      "ndc_label_name": "Alendronate Sodium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980034003",
      "ndc_label_name": "Alendronate Sodium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071079030",
      "ndc_label_name": "Alendronate Sodium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714063202",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097022376",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135071812",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135069612",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714063201",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543013004",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090547400",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135071844",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111059048",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543013012",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980034114",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135069644",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862032804",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090109100",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090407600",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097022316",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071157704",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282068145",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111058930",
      "ndc_label_name": "Alendronate Sodium Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111058901",
      "ndc_label_name": "Alendronate Sodium Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071079130",
      "ndc_label_name": "Alendronate Sodium Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714063301",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135069720",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135069712",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788713004",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135071912",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090312600",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714063302",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356059404",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543013104",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135069744",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090232200",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090258700",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135071944",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980034201",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097022476",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090312601",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111059248",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090232201",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090258701",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090567700",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788823504",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980034214",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282068245",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862032904",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090469201",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090469200",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090567701",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205004804",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097022416",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543013120",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518003300",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919068904",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69543013112",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518003301",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71850182701",
      "ndc_label_name": "AlevaMax Cream External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927374500",
      "ndc_label_name": "Alfalfa Flavor POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478006702",
      "ndc_label_name": "Alfentanil HCl Solution 1000 MCG/2ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478006705",
      "ndc_label_name": "Alfentanil HCl Solution 2500 MCG/5ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54746000101",
      "ndc_label_name": "Alferon N Solution 5000000 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440500090",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353094560",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300015519",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440500005",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440500081",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353094516",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440500001",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335095688",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300015501",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282030210",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237011490",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668002105",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353074660",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282030290",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440500030",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505285009",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407082990",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335095681",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097084407",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282030201",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353094530",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919034930",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440500060",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282030205",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862024901",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668002101",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335095618",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353074630",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162144909",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629235301",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282030212",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629235401",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629929501",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097084412",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452025002",
      "ndc_label_name": "Alginic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452025004",
      "ndc_label_name": "Alginic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927276800",
      "ndc_label_name": "Alginic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452025001",
      "ndc_label_name": "Alginic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00169208015",
      "ndc_label_name": "Alhemo Solution Pen-Injector 150 MG/1.5ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00169208103",
      "ndc_label_name": "Alhemo Solution Pen-Injector 300 MG/3ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00169208415",
      "ndc_label_name": "Alhemo Solution Pen-Injector 60 MG/1.5ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993014130",
      "ndc_label_name": "Aliskiren Fumarate Tablet 150 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884042411",
      "ndc_label_name": "Aliskiren Fumarate Tablet 150 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884042511",
      "ndc_label_name": "Aliskiren Fumarate Tablet 300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993014230",
      "ndc_label_name": "Aliskiren Fumarate Tablet 300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52609300100",
      "ndc_label_name": "Alkeran Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52609000105",
      "ndc_label_name": "Alkeran Tablet 2 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71863010950",
      "ndc_label_name": "Alkindi Sprinkle Capsule Sprinkle 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71863011050",
      "ndc_label_name": "Alkindi Sprinkle Capsule Sprinkle 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71863011150",
      "ndc_label_name": "Alkindi Sprinkle Capsule Sprinkle 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71863011250",
      "ndc_label_name": "Alkindi Sprinkle Capsule Sprinkle 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927373900",
      "ndc_label_name": "Alkyl Acrylate Crosspolymer POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927243300",
      "ndc_label_name": "Alkyl Benzoate C12-15 Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462551100",
      "ndc_label_name": "All Flow 1000 PFT Filter DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462552100",
      "ndc_label_name": "All Flow 2000 PFT Filter DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462552000",
      "ndc_label_name": "All Flow 2000 PFT Filter DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462553000",
      "ndc_label_name": "All Flow 3000 PFT Filter DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462553100",
      "ndc_label_name": "All Flow 3000 PFT Filter DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462554000",
      "ndc_label_name": "All Flow 4000 PFT Filter DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462554100",
      "ndc_label_name": "All Flow 4000 PFT Filter DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462555000",
      "ndc_label_name": "All Flow 5000 PFT Filter DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462555100",
      "ndc_label_name": "All Flow 5000 PFT Filter DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462556100",
      "ndc_label_name": "All Flow 6000 PFT Filter DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462556000",
      "ndc_label_name": "All Flow 6000 PFT Filter DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462557000",
      "ndc_label_name": "All Flow 7000 PFT Filter DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462557100",
      "ndc_label_name": "All Flow 7000 PFT Filter DEVICE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452026001",
      "ndc_label_name": "Allantoin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452026004",
      "ndc_label_name": "Allantoin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552017905",
      "ndc_label_name": "Allantoin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452026002",
      "ndc_label_name": "Allantoin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452026003",
      "ndc_label_name": "Allantoin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452026006",
      "ndc_label_name": "Allantoin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927476800",
      "ndc_label_name": "Allantoin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452026005",
      "ndc_label_name": "Allantoin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927125800",
      "ndc_label_name": "Allantoin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927191500",
      "ndc_label_name": "Allopurinol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000804",
      "ndc_label_name": "Allopurinol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000802",
      "ndc_label_name": "Allopurinol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000801",
      "ndc_label_name": "Allopurinol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452000803",
      "ndc_label_name": "Allopurinol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143953301",
      "ndc_label_name": "Allopurinol Sodium SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219038030",
      "ndc_label_name": "Allopurinol Sodium Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591554301",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904704161",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378013710",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705085",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722025201",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705030",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571088309",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378013701",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591554310",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714004110",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705081",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603211521",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063097590",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714057602",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714004107",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705091",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571088310",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729013416",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705090",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603211532",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090466203",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300034901",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714057601",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729013401",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155069301",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090376003",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714004112",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300034905",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090769700",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300034910",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714057603",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063007990",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155069310",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090466204",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722025205",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722025210",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090783300",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063079320",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714057604",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090376004",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063007920",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090769603",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063007960",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090254403",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135051631",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090516803",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063079390",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090671600",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063007930",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111072910",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063093501",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090671503",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62584098811",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090783201",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063097520",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489015610",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063079360",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651028501",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090769604",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090783200",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267066530",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006315",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090516804",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700087990",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090254404",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629167504",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079020520",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687067701",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788402701",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959047300",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006311",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429018018",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090671504",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629211101",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489015601",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919074830",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788872701",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959047330",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700094790",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760065690",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079020501",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739041010",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760013490",
      "ndc_label_name": "Allopurinol TABLET 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135051690",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315029110",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687067711",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651028599",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760071090",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489015605",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267066560",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919074890",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544098860",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518045104",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335254202",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544073680",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62584098801",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111072901",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544073660",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304053901",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788738303",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921024001",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189043790",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544098880",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544073630",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118211503",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788402703",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267066590",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788738309",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187046390",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788872709",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788402709",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788402706",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304053910",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518045101",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544073674",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69967000803",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544098830",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934020930",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788738301",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833701",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788845809",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921024060",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833703",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518167801",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788872703",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162114900",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315029101",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833706",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69967000801",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921024050",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833709",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315029105",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710120901",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205020830",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710120900",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610019460",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934007230",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610019480",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788845801",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610094960",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205020890",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610094980",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610019760",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610019430",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788845803",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610019780",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788845806",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788872706",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518045100",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518045102",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518045103",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571088409",
      "ndc_label_name": "Allopurinol Tablet 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921024109",
      "ndc_label_name": "Allopurinol Tablet 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710200909",
      "ndc_label_name": "Allopurinol Tablet 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315040909",
      "ndc_label_name": "Allopurinol Tablet 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705185",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603211621",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378018105",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705190",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705160",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705130",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378018101",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571088509",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904657261",
      "ndc_label_name": "Allopurinol TABLET 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714004210",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591554405",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591554401",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714057701",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705191",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440705181",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571088550",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090186700",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729013516",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603211628",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155069401",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155069405",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300035001",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603211632",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090186703",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001001",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722025305",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714057702",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090688201",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722025310",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300035010",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904261460",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090735101",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700054090",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353018660",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063077490",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079020601",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063077430",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722025301",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714004211",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959031100",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187024090",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090004400",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999024503",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489015705",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090519401",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063093401",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729013501",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489015701",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267022460",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090466300",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006411",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001090",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090688200",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063097690",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300035005",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788754203",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788836403",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959031160",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651028605",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760098990",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090696800",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353008860",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063097630",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788836401",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788842409",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111073005",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919047130",
      "ndc_label_name": "Allopurinol TABLET 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919047190",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489015710",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090186701",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090004403",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788871309",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315029205",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001030",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135051731",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629211201",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111073001",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090466303",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090466301",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315029201",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315029210",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687068801",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135051790",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544037160",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001003",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090688203",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090519400",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69967000901",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518180602",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760013990",
      "ndc_label_name": "Allopurinol TABLET 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544037130",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788632303",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651028601",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090735100",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090519403",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518157301",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934050430",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304054001",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788871303",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006445",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687068811",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090735103",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959031130",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189064790",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205004930",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267022430",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710121001",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425020602",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62584071311",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090735300",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700093590",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425038301",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425051801",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788842401",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162115000",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006415",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304054005",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518157302",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62584071301",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079020620",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425051802",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610023160",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162115005",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267022490",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629211301",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610068145",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739079610",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788886503",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788632301",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921024201",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425020601",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69967000902",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788754209",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921024260",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544031360",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518180600",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788886501",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189041790",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788754201",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518180601",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788886506",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006460",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788836409",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610068160",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518328900",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921024250",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788842403",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425038302",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710121005",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788871301",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205037790",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788886509",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518157300",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610025360",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68047075201",
      "ndc_label_name": "Allzital Tablet 25-325 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "22840578105",
      "ndc_label_name": "Almond (Diagnostic) Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779097505",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779097507",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452027003",
      "ndc_label_name": "Almond Oil (Sweet) Oil",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552012804",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779303501",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779249008",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991295902",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779097501",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779097508",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779097509",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991295903",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779249005",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452027004",
      "ndc_label_name": "Almond Oil (Sweet) Oil",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779249009",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779249001",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779303507",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552012808",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779303509",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779303505",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552012807",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779303508",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452027002",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452027001",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991295901",
      "ndc_label_name": "Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991295905",
      "ndc_label_name": "Almond Oil (Sweet) Oil",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927217200",
      "ndc_label_name": "Almond Oil Bitter Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927490400",
      "ndc_label_name": "Almond Oil Bitter Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378524685",
      "ndc_label_name": "Almotriptan Malate TABLET 12.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241004221",
      "ndc_label_name": "Almotriptan Malate TABLET 12.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241004268",
      "ndc_label_name": "Almotriptan Malate TABLET 12.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378524632",
      "ndc_label_name": "Almotriptan Malate Tablet 12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378524585",
      "ndc_label_name": "Almotriptan Malate TABLET 6.25 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378524532",
      "ndc_label_name": "Almotriptan Malate Tablet 6.25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241004168",
      "ndc_label_name": "Almotriptan Malate TABLET 6.25 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241004111",
      "ndc_label_name": "Almotriptan Malate TABLET 6.25 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023884205",
      "ndc_label_name": "Alocril SOLUTION 2 % OPHTHALMIC",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288145225",
      "ndc_label_name": "Aloe Vera Freeze Dried POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991253201",
      "ndc_label_name": "Aloe Vera Leaf POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991253202",
      "ndc_label_name": "Aloe Vera Leaf POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452028802",
      "ndc_label_name": "Aloe Vera Oil",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779097608",
      "ndc_label_name": "Aloe Vera OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779097605",
      "ndc_label_name": "Aloe Vera OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452028801",
      "ndc_label_name": "Aloe Vera Oil",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927263400",
      "ndc_label_name": "Aloe Vera OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452028803",
      "ndc_label_name": "Aloe Vera Oil",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452028702",
      "ndc_label_name": "Aloe Vera POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779097703",
      "ndc_label_name": "Aloe Vera POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779097705",
      "ndc_label_name": "Aloe Vera POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779097704",
      "ndc_label_name": "Aloe Vera POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552057105",
      "ndc_label_name": "Aloe Vera POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452028703",
      "ndc_label_name": "Aloe Vera POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552057104",
      "ndc_label_name": "Aloe Vera POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452028701",
      "ndc_label_name": "Aloe Vera POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552057102",
      "ndc_label_name": "Aloe Vera POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779097708",
      "ndc_label_name": "Aloe Vera POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927180600",
      "ndc_label_name": "Aloe Vera POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610066109",
      "ndc_label_name": "Alogliptin Benzoate Tablet 12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802010365",
      "ndc_label_name": "Alogliptin Benzoate Tablet 12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610066118",
      "ndc_label_name": "Alogliptin Benzoate Tablet 12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090557400",
      "ndc_label_name": "Alogliptin Benzoate Tablet 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030060",
      "ndc_label_name": "Alogliptin Benzoate Tablet 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030009",
      "ndc_label_name": "Alogliptin Benzoate Tablet 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802015065",
      "ndc_label_name": "Alogliptin Benzoate Tablet 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030018",
      "ndc_label_name": "Alogliptin Benzoate Tablet 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802008765",
      "ndc_label_name": "Alogliptin Benzoate Tablet 6.25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802021172",
      "ndc_label_name": "Alogliptin-metFORMIN HCl Tablet 12.5-1000 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090599300",
      "ndc_label_name": "Alogliptin-metFORMIN HCl Tablet 12.5-1000 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802016972",
      "ndc_label_name": "Alogliptin-metFORMIN HCl Tablet 12.5-500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802023865",
      "ndc_label_name": "Alogliptin-Pioglitazone Tablet 12.5-15 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802026065",
      "ndc_label_name": "Alogliptin-Pioglitazone Tablet 12.5-30 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802030465",
      "ndc_label_name": "Alogliptin-Pioglitazone Tablet 12.5-45 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802035165",
      "ndc_label_name": "Alogliptin-Pioglitazone Tablet 25-15 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802040265",
      "ndc_label_name": "Alogliptin-Pioglitazone Tablet 25-30 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802049965",
      "ndc_label_name": "Alogliptin-Pioglitazone Tablet 25-45 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078073610",
      "ndc_label_name": "Alomide Solution 0.1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065034510",
      "ndc_label_name": "Alomide Solution 0.1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457097850",
      "ndc_label_name": "Aloprim Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457018750",
      "ndc_label_name": "Aloprim SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162024803",
      "ndc_label_name": "Alosetron HCl TABLET 0.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054029513",
      "ndc_label_name": "Alosetron HCl Tablet 0.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73190003530",
      "ndc_label_name": "Alosetron HCl Tablet 0.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884081911",
      "ndc_label_name": "Alosetron HCl Tablet 0.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980045303",
      "ndc_label_name": "Alosetron HCl Tablet 0.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746024830",
      "ndc_label_name": "Alosetron HCl Tablet 0.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963047903",
      "ndc_label_name": "Alosetron HCl Tablet 0.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756070230",
      "ndc_label_name": "Alosetron HCl Tablet 0.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930001030",
      "ndc_label_name": "Alosetron HCl Tablet 0.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884082011",
      "ndc_label_name": "Alosetron HCl Tablet 1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054029613",
      "ndc_label_name": "Alosetron HCl Tablet 1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756070130",
      "ndc_label_name": "Alosetron HCl Tablet 1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73190003630",
      "ndc_label_name": "Alosetron HCl Tablet 1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963048003",
      "ndc_label_name": "Alosetron HCl Tablet 1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980045403",
      "ndc_label_name": "Alosetron HCl Tablet 1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746024930",
      "ndc_label_name": "Alosetron HCl Tablet 1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162024903",
      "ndc_label_name": "Alosetron HCl TABLET 1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930001130",
      "ndc_label_name": "Alosetron HCl Tablet 1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "87007000101",
      "ndc_label_name": "Alpha Lipoic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927486300",
      "ndc_label_name": "Alpha-GPC 50% POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452088903",
      "ndc_label_name": "Alpha-Ketoglutaric Acid Crystals",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452088901",
      "ndc_label_name": "Alpha-Ketoglutaric Acid Crystals",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452088902",
      "ndc_label_name": "Alpha-Ketoglutaric Acid Crystals",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452088904",
      "ndc_label_name": "Alpha-Ketoglutaric Acid Crystals",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779097809",
      "ndc_label_name": "Alpha-Ketoglutaric Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779097804",
      "ndc_label_name": "Alpha-Ketoglutaric Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779097805",
      "ndc_label_name": "Alpha-Ketoglutaric Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779253504",
      "ndc_label_name": "Alpha-Lipoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10695031050",
      "ndc_label_name": "Alpha-Lipoic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779255803",
      "ndc_label_name": "Alpha-Lipoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779253503",
      "ndc_label_name": "Alpha-Lipoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452408306",
      "ndc_label_name": "Alpha-Lipoic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10695031070",
      "ndc_label_name": "Alpha-Lipoic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991254202",
      "ndc_label_name": "Alpha-Lipoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779255808",
      "ndc_label_name": "Alpha-Lipoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779253505",
      "ndc_label_name": "Alpha-Lipoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779253506",
      "ndc_label_name": "Alpha-Lipoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452408303",
      "ndc_label_name": "Alpha-Lipoic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779253509",
      "ndc_label_name": "Alpha-Lipoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457996601",
      "ndc_label_name": "Alpha-Lipoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779255805",
      "ndc_label_name": "Alpha-Lipoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457996602",
      "ndc_label_name": "Alpha-Lipoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457996605",
      "ndc_label_name": "Alpha-Lipoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452408302",
      "ndc_label_name": "Alpha-Lipoic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288122710",
      "ndc_label_name": "Alpha-Lipoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592041822",
      "ndc_label_name": "Alpha-Lipoic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452408304",
      "ndc_label_name": "Alpha-Lipoic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452408305",
      "ndc_label_name": "Alpha-Lipoic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927506400",
      "ndc_label_name": "Alpha-Lipoic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592041825",
      "ndc_label_name": "Alpha-Lipoic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592041811",
      "ndc_label_name": "Alpha-Lipoic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457996603",
      "ndc_label_name": "Alpha-Lipoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592041801",
      "ndc_label_name": "Alpha-Lipoic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991254201",
      "ndc_label_name": "Alpha-Lipoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991254203",
      "ndc_label_name": "Alpha-Lipoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457996604",
      "ndc_label_name": "Alpha-Lipoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991254204",
      "ndc_label_name": "Alpha-Lipoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72627240601",
      "ndc_label_name": "Alpha-Lipoic Acid Solution 25 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927453400",
      "ndc_label_name": "Alpha-Tocopherol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023932105",
      "ndc_label_name": "Alphagan P Solution 0.1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023932110",
      "ndc_label_name": "Alphagan P Solution 0.1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023932115",
      "ndc_label_name": "Alphagan P Solution 0.1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023917710",
      "ndc_label_name": "Alphagan P SOLUTION 0.15 % OPHTHALMIC",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023917705",
      "ndc_label_name": "Alphagan P SOLUTION 0.15 % OPHTHALMIC",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023917715",
      "ndc_label_name": "Alphagan P SOLUTION 0.15 % OPHTHALMIC",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779752601",
      "ndc_label_name": "AlphaMop Foam Replacement Pads",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516461302",
      "ndc_label_name": "Alphanate Solution Reconstituted 1000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516460702",
      "ndc_label_name": "Alphanate Solution Reconstituted 1000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516461802",
      "ndc_label_name": "Alphanate Solution Reconstituted 1000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516461402",
      "ndc_label_name": "Alphanate Solution Reconstituted 1500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516460802",
      "ndc_label_name": "Alphanate Solution Reconstituted 1500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516461902",
      "ndc_label_name": "Alphanate Solution Reconstituted 1500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516461002",
      "ndc_label_name": "Alphanate Solution Reconstituted 2000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516461502",
      "ndc_label_name": "Alphanate Solution Reconstituted 2000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516462002",
      "ndc_label_name": "Alphanate Solution Reconstituted 2000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516461101",
      "ndc_label_name": "Alphanate Solution Reconstituted 250 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516461601",
      "ndc_label_name": "Alphanate Solution Reconstituted 250 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516460501",
      "ndc_label_name": "Alphanate Solution Reconstituted 250 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516461201",
      "ndc_label_name": "Alphanate Solution Reconstituted 500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516460601",
      "ndc_label_name": "Alphanate Solution Reconstituted 500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516461701",
      "ndc_label_name": "Alphanate Solution Reconstituted 500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516360802",
      "ndc_label_name": "AlphaNine SD Solution Reconstituted 1000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516360502",
      "ndc_label_name": "AlphaNine SD Solution Reconstituted 1000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516361102",
      "ndc_label_name": "AlphaNine SD Solution Reconstituted 1000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516360602",
      "ndc_label_name": "AlphaNine SD Solution Reconstituted 1500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516361202",
      "ndc_label_name": "AlphaNine SD Solution Reconstituted 1500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516360902",
      "ndc_label_name": "AlphaNine SD Solution Reconstituted 1500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516360702",
      "ndc_label_name": "AlphaNine SD Solution Reconstituted 500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516360402",
      "ndc_label_name": "AlphaNine SD Solution Reconstituted 500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68516361002",
      "ndc_label_name": "AlphaNine SD Solution Reconstituted 500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228308306",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959096430",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335112902",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335112903",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335112901",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862045460",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162105902",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335112904",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162105903",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162105906",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162105909",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629536402",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959096515",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228308406",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090755601",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959096560",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959096530",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335183902",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862045560",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788694303",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629536403",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189002990",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189002960",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629536401",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335183901",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788694306",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788694309",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518287000",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189002930",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228308706",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862045660",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862045760",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228308606",
      "ndc_label_name": "ALPRAZolam ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054306844",
      "ndc_label_name": "ALPRAZolam Intensol CONCENTRATE 1 MG/ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779199309",
      "ndc_label_name": "ALPRAZolam POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779199301",
      "ndc_label_name": "ALPRAZolam POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991280503",
      "ndc_label_name": "ALPRAZolam POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991280501",
      "ndc_label_name": "ALPRAZolam POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779199304",
      "ndc_label_name": "ALPRAZolam POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452029503",
      "ndc_label_name": "ALPRAZolam Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452029501",
      "ndc_label_name": "ALPRAZolam Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779199306",
      "ndc_label_name": "ALPRAZolam POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991280502",
      "ndc_label_name": "ALPRAZolam POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991280504",
      "ndc_label_name": "ALPRAZolam POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452029504",
      "ndc_label_name": "ALPRAZolam Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452029502",
      "ndc_label_name": "ALPRAZolam Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452029505",
      "ndc_label_name": "ALPRAZolam Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781106101",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202750",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707006",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202710",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090225604",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707030",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707090",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202796",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090525700",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781106105",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070530",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781106110",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268003311",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707060",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035760",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035753",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268003315",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035730",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070405",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070553",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032100",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035715",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090225600",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070560",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070401",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035770",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687037711",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070410",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032110",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070570",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032102",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090225601",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032114",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070515",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187091630",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032160",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700067160",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032120",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032190",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762371904",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841402",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090186400",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041430",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041445",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762371901",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762371903",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267021990",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067699",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966705",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032130",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841406",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041460",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687037701",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067605",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041453",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041480",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011230",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067601",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841409",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073470",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267021960",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073415",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041470",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073430",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069645",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841403",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335157601",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804002730",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041415",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073460",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073445",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966701",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073453",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073480",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011260",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011270",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759402",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759406",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011253",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004230",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759403",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759409",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008730",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008706",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069630",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205029030",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789015106",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205071830",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789015130",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707110",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202910",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107705",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035845",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707130",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707103",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107701",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202950",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090278101",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707190",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055530",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035853",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035830",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707106",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035892",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202996",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090507802",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035880",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055545",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055520",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055575",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107710",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999003260",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707160",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045742",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055515",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055580",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055560",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526101",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035860",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090507801",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707191",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045745",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055553",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090175900",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055570",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070505",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035870",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436463501",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035820",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045790",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055555",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090175902",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055592",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372001",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999003215",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436463502",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035875",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092930",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055590",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268003415",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090507803",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084930",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090278103",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070510",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090175901",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372003",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526100",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045702",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045715",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772603",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090507800",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045728",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526102",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038811",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526103",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045730",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045720",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772608",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070501",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045760",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045700",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067701",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268003411",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772606",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002039510",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772609",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002039505",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002039515",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002039520",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041592",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772600",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772607",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038801",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041545",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067705",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002039530",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772604",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839809",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772601",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041553",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772602",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041560",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425016102",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372004",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772605",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335084906",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067799",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041570",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041520",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041575",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759503",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041515",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071201509",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335109206",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759509",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759508",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041530",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759502",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073475",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041580",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759506",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966602",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073480",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205065230",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335109202",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839803",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044290",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841006",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031330",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966605",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002430",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335084905",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335109205",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839806",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002490",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189024030",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031390",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073430",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031306",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073415",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966601",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841003",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028401",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073453",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073460",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073445",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028402",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002460",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073470",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841009",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044202",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044230",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002406",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205028430",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009902",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031360",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804003530",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063060990",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228203150",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228203196",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107905",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707290",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035930",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107901",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228203110",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268003515",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707230",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063060940",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035960",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107910",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035953",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356074460",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707291",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052410",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063060930",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057230",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035980",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356074430",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052430",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035970",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063060960",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372101",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057260",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057253",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035990",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057280",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919000630",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035975",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035945",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372104",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057275",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057290",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057270",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090242503",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187044330",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052490",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057215",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000755",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090289602",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999025230",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090289601",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436463603",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067899",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429050415",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090242501",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032830",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090525801",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090242502",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090525803",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070610",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000775",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429050418",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090289603",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008930",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090525802",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052402",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436463601",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008960",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034770",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067805",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070601",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000715",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268003511",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052428",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436463602",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759603",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034775",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034745",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052400",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759606",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052414",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052460",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070605",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839406",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205022730",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034790",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052406",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205061430",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034715",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760055030",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118060509",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966003",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034755",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839403",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372103",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011360",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034780",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760067830",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919063960",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011370",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518278500",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839409",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083630",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044360",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518325900",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919000660",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083690",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425011002",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189021330",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205022710",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638101",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067801",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425044401",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011353",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000745",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034760",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759608",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189021360",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034730",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759609",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205061402",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032860",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034753",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011330",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335138605",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425010001",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759602",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044330",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966005",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425044402",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839402",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001030",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839408",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425010002",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090281901",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086400",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228203910",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070705",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707360",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052301",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526201",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781108905",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086410",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086460",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781108901",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086490",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707390",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761303",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372203",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070701",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052390",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052330",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086430",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267056491",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052340",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189012160",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067901",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086440",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761302",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052360",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788943002",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919057660",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919057690",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372201",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189005860",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788943003",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761306",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067905",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788943009",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788943006",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761309",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335189403",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189045060",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228401911",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 0.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884011052",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 0.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884011074",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 0.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884011174",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228402211",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189063702",
      "ndc_label_name": "ALPRAZolam Tablet Dispersible 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884011152",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884021352",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884021374",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228402411",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884021474",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884021452",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228402511",
      "ndc_label_name": "ALPRAZolam TABLET DISPERSIBLE 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762005701",
      "ndc_label_name": "ALPRAZolam XR Tablet Extended Release 24 Hour 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762005901",
      "ndc_label_name": "ALPRAZolam XR Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762006601",
      "ndc_label_name": "ALPRAZolam XR Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762006801",
      "ndc_label_name": "ALPRAZolam XR Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71104092201",
      "ndc_label_name": "Alprolix Solution Reconstituted 1000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104095409",
      "ndc_label_name": "Alprolix Solution Reconstituted 1000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104095509",
      "ndc_label_name": "Alprolix Solution Reconstituted 2000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104093301",
      "ndc_label_name": "Alprolix Solution Reconstituted 2000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104095201",
      "ndc_label_name": "Alprolix Solution Reconstituted 250 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104096601",
      "ndc_label_name": "Alprolix Solution Reconstituted 250 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104094401",
      "ndc_label_name": "Alprolix Solution Reconstituted 3000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104095609",
      "ndc_label_name": "Alprolix Solution Reconstituted 3000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104095109",
      "ndc_label_name": "Alprolix Solution Reconstituted 4000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104097701",
      "ndc_label_name": "Alprolix Solution Reconstituted 4000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104095309",
      "ndc_label_name": "Alprolix Solution Reconstituted 500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104091101",
      "ndc_label_name": "Alprolix Solution Reconstituted 500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779094406",
      "ndc_label_name": "Alprostadil POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452007304",
      "ndc_label_name": "Alprostadil POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927219600",
      "ndc_label_name": "Alprostadil POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779094407",
      "ndc_label_name": "Alprostadil POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552049809",
      "ndc_label_name": "Alprostadil POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457989701",
      "ndc_label_name": "Alprostadil POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452007305",
      "ndc_label_name": "Alprostadil POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452007303",
      "ndc_label_name": "Alprostadil POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779094409",
      "ndc_label_name": "Alprostadil POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552049805",
      "ndc_label_name": "Alprostadil POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552049804",
      "ndc_label_name": "Alprostadil Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552049802",
      "ndc_label_name": "Alprostadil POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052014605",
      "ndc_label_name": "Alprostadil Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452007306",
      "ndc_label_name": "Alprostadil Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552049803",
      "ndc_label_name": "Alprostadil POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052014601",
      "ndc_label_name": "Alprostadil Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457989702",
      "ndc_label_name": "Alprostadil POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052014625",
      "ndc_label_name": "Alprostadil Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457989703",
      "ndc_label_name": "Alprostadil POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208035305",
      "ndc_label_name": "Alrex Suspension 0.2 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208035310",
      "ndc_label_name": "Alrex Suspension 0.2 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16110051830",
      "ndc_label_name": "Altabax Ointment 1 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16110051815",
      "ndc_label_name": "Altabax Ointment 1 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61570011001",
      "ndc_label_name": "Altace Capsule 1.25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61570012001",
      "ndc_label_name": "Altace Capsule 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61570011101",
      "ndc_label_name": "Altace Capsule 2.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999093430",
      "ndc_label_name": "Altace Capsule 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61570011201",
      "ndc_label_name": "Altace Capsule 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59390019405",
      "ndc_label_name": "Altafrin Solution 10 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59390019313",
      "ndc_label_name": "Altafrin Solution 2.5 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700011685",
      "ndc_label_name": "Altavera Tablet 0.15-30 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700011684",
      "ndc_label_name": "Altavera Tablet 0.15-30 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840560005",
      "ndc_label_name": "Alternaria alternat (Diagnost) Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70515062830",
      "ndc_label_name": "Altoprev Tablet Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70515062930",
      "ndc_label_name": "Altoprev Tablet Extended Release 24 Hour 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70515063030",
      "ndc_label_name": "Altoprev Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779229404",
      "ndc_label_name": "Altrenogest POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457982801",
      "ndc_label_name": "Altrenogest Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052000625",
      "ndc_label_name": "Altrenogest Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779229405",
      "ndc_label_name": "Altrenogest POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "28595072130",
      "ndc_label_name": "Altrixa OB Tablet 15-0.4-0.6 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104098101",
      "ndc_label_name": "Altuviiio Solution Reconstituted 1000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104098808",
      "ndc_label_name": "Altuviiio Solution Reconstituted 1000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104098908",
      "ndc_label_name": "Altuviiio Solution Reconstituted 2000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104098201",
      "ndc_label_name": "Altuviiio Solution Reconstituted 2000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104098508",
      "ndc_label_name": "Altuviiio Solution Reconstituted 250 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104097801",
      "ndc_label_name": "Altuviiio Solution Reconstituted 250 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104099008",
      "ndc_label_name": "Altuviiio Solution Reconstituted 3000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104098301",
      "ndc_label_name": "Altuviiio Solution Reconstituted 3000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104098401",
      "ndc_label_name": "Altuviiio Solution Reconstituted 4000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104099108",
      "ndc_label_name": "Altuviiio Solution Reconstituted 4000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104097901",
      "ndc_label_name": "Altuviiio Solution Reconstituted 500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104098608",
      "ndc_label_name": "Altuviiio Solution Reconstituted 500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71104098001",
      "ndc_label_name": "Altuviiio Solution Reconstituted 750 UNIT Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00395004912",
      "ndc_label_name": "Alum Ammonium (Bulk) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00395004996",
      "ndc_label_name": "Alum Ammonium (Bulk) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927338700",
      "ndc_label_name": "Aluminum Acetate Basic POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452001201",
      "ndc_label_name": "Aluminum Ammonium Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452001202",
      "ndc_label_name": "Aluminum Ammonium Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779068509",
      "ndc_label_name": "Aluminum Chloride Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779068508",
      "ndc_label_name": "Aluminum Chloride Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779068505",
      "ndc_label_name": "Aluminum Chloride Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552018505",
      "ndc_label_name": "Aluminum Chloride CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552018507",
      "ndc_label_name": "Aluminum Chloride CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927128600",
      "ndc_label_name": "Aluminum Chloride Hexahydrate CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284002",
      "ndc_label_name": "Aluminum Chloride Hexahydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452033002",
      "ndc_label_name": "Aluminum Chloride Hexahydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452033001",
      "ndc_label_name": "Aluminum Chloride Hexahydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452033006",
      "ndc_label_name": "Aluminum Chloride Hexahydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284003",
      "ndc_label_name": "Aluminum Chloride Hexahydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284001",
      "ndc_label_name": "Aluminum Chloride Hexahydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452033503",
      "ndc_label_name": "Aluminum Chlorohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927109200",
      "ndc_label_name": "Aluminum Chlorohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452033502",
      "ndc_label_name": "Aluminum Chlorohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452033501",
      "ndc_label_name": "Aluminum Chlorohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779676903",
      "ndc_label_name": "Aluminum Flip Off Seals 20mm",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779677202",
      "ndc_label_name": "Aluminum Flip Off Seals 20mm",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779677002",
      "ndc_label_name": "Aluminum Flip Off Seals 20mm",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779676902",
      "ndc_label_name": "Aluminum Flip Off Seals 20mm",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779677203",
      "ndc_label_name": "Aluminum Flip Off Seals 20mm",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779677601",
      "ndc_label_name": "Aluminum Flip Off Seals 20mm",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779677502",
      "ndc_label_name": "Aluminum Flip Off Seals 20mm",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779677602",
      "ndc_label_name": "Aluminum Flip Off Seals 20mm",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779677201",
      "ndc_label_name": "Aluminum Flip Off Seals 20mm",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779677702",
      "ndc_label_name": "Aluminum Flip Off Seals 20mm",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779677102",
      "ndc_label_name": "Aluminum Flip Off Seals 20mm",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779681701",
      "ndc_label_name": "Aluminum Flip Off Seals 20mm",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779677402",
      "ndc_label_name": "Aluminum Flip Off Seals 20mm",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779677802",
      "ndc_label_name": "Aluminum Flip Off Seals 20mm",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452035002",
      "ndc_label_name": "Aluminum Hydroxide Dried Gel POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452035003",
      "ndc_label_name": "Aluminum Hydroxide Dried Gel POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552119604",
      "ndc_label_name": "Aluminum Hydroxide Dried Gel POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452035001",
      "ndc_label_name": "Aluminum Hydroxide Dried Gel POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552119607",
      "ndc_label_name": "Aluminum Hydroxide Dried Gel POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552119605",
      "ndc_label_name": "Aluminum Hydroxide Dried Gel POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552119606",
      "ndc_label_name": "Aluminum Hydroxide Dried Gel POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927109100",
      "ndc_label_name": "Aluminum Hydroxide Dried Gel POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284103",
      "ndc_label_name": "Aluminum Hydroxide Dried Gel POWDER 100 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284102",
      "ndc_label_name": "Aluminum Hydroxide Dried Gel POWDER 100 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284101",
      "ndc_label_name": "Aluminum Hydroxide Dried Gel POWDER 100 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284104",
      "ndc_label_name": "Aluminum Hydroxide Dried Gel POWDER 100 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927516700",
      "ndc_label_name": "Aluminum Hydroxide Gel Powder 100 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452037002",
      "ndc_label_name": "Aluminum Potassium Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452037001",
      "ndc_label_name": "Aluminum Potassium Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927169200",
      "ndc_label_name": "Aluminum Potassium Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452038001",
      "ndc_label_name": "Aluminum Sulfate Crystals",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452038002",
      "ndc_label_name": "Aluminum Sulfate Crystals",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452038003",
      "ndc_label_name": "Aluminum Sulfate Crystals",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927164600",
      "ndc_label_name": "Aluminum Sulfate GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63020018030",
      "ndc_label_name": "Alunbrig Tablet 180 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63020011330",
      "ndc_label_name": "Alunbrig Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63020009007",
      "ndc_label_name": "Alunbrig Tablet 90 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63020009030",
      "ndc_label_name": "Alunbrig Tablet 90 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63020019830",
      "ndc_label_name": "Alunbrig Tablet Therapy Pack 90 & 180 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480327456",
      "ndc_label_name": "Alvaiz Tablet 18 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480327556",
      "ndc_label_name": "Alvaiz Tablet 36 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480327656",
      "ndc_label_name": "Alvaiz Tablet 54 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480327356",
      "ndc_label_name": "Alvaiz Tablet 9 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70515071201",
      "ndc_label_name": "Alvesco Aerosol Solution 160 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70515071205",
      "ndc_label_name": "Alvesco Aerosol Solution 160 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70515071105",
      "ndc_label_name": "Alvesco Aerosol Solution 80 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70515071101",
      "ndc_label_name": "Alvesco Aerosol Solution 80 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090147700",
      "ndc_label_name": "Alyacen 1/35 Tablet 1-35 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462039429",
      "ndc_label_name": "Alyacen 1/35 TABLET 1-35 MG-MCG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462039484",
      "ndc_label_name": "Alyacen 1/35 TABLET 1-35 MG-MCG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090147800",
      "ndc_label_name": "Alyacen 7/7/7 Tablet 0.5/0.75/1-35 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462055629",
      "ndc_label_name": "Alyacen 7/7/7 TABLET 0.5/0.75/1-35 MG-MCG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462055684",
      "ndc_label_name": "Alyacen 7/7/7 TABLET 0.5/0.75/1-35 MG-MCG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51167012101",
      "ndc_label_name": "Alyftrek Tablet 10-50-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51167013501",
      "ndc_label_name": "Alyftrek Tablet 4-20-50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61476010402",
      "ndc_label_name": "Alyglo Solution 10 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61476010410",
      "ndc_label_name": "Alyglo Solution 10 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61476010403",
      "ndc_label_name": "Alyglo Solution 20 GM/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61476010420",
      "ndc_label_name": "Alyglo Solution 20 GM/200ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61476010405",
      "ndc_label_name": "Alyglo Solution 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61476010401",
      "ndc_label_name": "Alyglo Solution 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480927706",
      "ndc_label_name": "Alyq Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093333406",
      "ndc_label_name": "Alyq Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180082973",
      "ndc_label_name": "Amabelz Tablet 0.5-0.1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180082971",
      "ndc_label_name": "Amabelz Tablet 0.5-0.1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180083071",
      "ndc_label_name": "Amabelz Tablet 1-0.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180083073",
      "ndc_label_name": "Amabelz Tablet 1-0.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440707510",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904704240",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440707506",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527170401",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353085318",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904704206",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440707520",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440707504",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155036205",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571083401",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006915",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832101500",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629268102",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543049305",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527170405",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687042211",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268006911",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155036201",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000710",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832101550",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001520",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000730",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904704259",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332024671",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000714",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291012550",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000715",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135069301",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788697503",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687042201",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904704261",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629268103",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000720",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353094705",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335291901",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571083450",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000760",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629268101",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135069305",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788697502",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135060990",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332024631",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189041230",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382051205",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001514",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629268104",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543049301",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788697504",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382051201",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452014230",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760077930",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788697501",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335266406",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73152007601",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205022320",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452014220",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003330",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162240805",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205070220",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335295901",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804019620",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003305",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162240801",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73152007605",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003301",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455082702",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60966014604",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50488100301",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779041104",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779041105",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455082704",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455082703",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455082701",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455082705",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991255905",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552110004",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779041109",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50488100302",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455082707",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455082706",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927175400",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452039504",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998205",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552110005",
      "ndc_label_name": "Amantadine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144014301",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552110007",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452039501",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452039502",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991255903",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288121810",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60966024603",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991255901",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998202",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998203",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998201",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452039503",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307002015",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75840010301",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991255904",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452039505",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307002011",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50488100300",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998204",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60966034602",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70859001201",
      "ndc_label_name": "Amantadine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00116401010",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383080710",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39328053099",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00116401041",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135001124",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383080712",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39328053010",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00116401016",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121064616",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135001047",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432009316",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687079742",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383080716",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121064610",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687079756",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39328053016",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135001159",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832011100",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189053530",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591492001",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832011103",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518338101",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135069205",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591492005",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543049705",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543049701",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73152007501",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746069901",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832011189",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832011150",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332058631",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135069201",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518338100",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73152007505",
      "ndc_label_name": "Amantadine HCl Tablet 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452039001",
      "ndc_label_name": "Amaranth POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779868801",
      "ndc_label_name": "Amber Glass Vials 2ml/13mm",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779871902",
      "ndc_label_name": "Amber Glass Vials 30ml/20mm",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289020530",
      "ndc_label_name": "Ambien CR Tablet Extended Release 12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024552131",
      "ndc_label_name": "Ambien CR Tablet Extended Release 12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629459701",
      "ndc_label_name": "Ambien CR Tablet Extended Release 12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713552101",
      "ndc_label_name": "Ambien CR Tablet Extended Release 12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071036130",
      "ndc_label_name": "Ambien CR Tablet Extended Release 12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959087030",
      "ndc_label_name": "Ambien CR Tablet Extended Release 12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353044330",
      "ndc_label_name": "Ambien CR Tablet Extended Release 12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024550131",
      "ndc_label_name": "Ambien CR Tablet Extended Release 6.25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713550101",
      "ndc_label_name": "Ambien CR Tablet Extended Release 6.25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289057230",
      "ndc_label_name": "Ambien CR Tablet Extended Release 6.25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036315",
      "ndc_label_name": "Ambien Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999003700",
      "ndc_label_name": "Ambien Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036320",
      "ndc_label_name": "Ambien Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999003710",
      "ndc_label_name": "Ambien Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036330",
      "ndc_label_name": "Ambien Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999003720",
      "ndc_label_name": "Ambien Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024542131",
      "ndc_label_name": "Ambien Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999003715",
      "ndc_label_name": "Ambien Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001620",
      "ndc_label_name": "Ambien TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036321",
      "ndc_label_name": "Ambien Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036325",
      "ndc_label_name": "Ambien Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036310",
      "ndc_label_name": "Ambien Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289079206",
      "ndc_label_name": "Ambien TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036360",
      "ndc_label_name": "Ambien Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713542101",
      "ndc_label_name": "Ambien Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289079220",
      "ndc_label_name": "Ambien TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289079212",
      "ndc_label_name": "Ambien TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289079230",
      "ndc_label_name": "Ambien TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001628",
      "ndc_label_name": "Ambien TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001612",
      "ndc_label_name": "Ambien TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001630",
      "ndc_label_name": "Ambien TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289079210",
      "ndc_label_name": "Ambien TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001660",
      "ndc_label_name": "Ambien TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001610",
      "ndc_label_name": "Ambien TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036215",
      "ndc_label_name": "Ambien Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289072912",
      "ndc_label_name": "Ambien TABLET 5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999045330",
      "ndc_label_name": "Ambien Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999045315",
      "ndc_label_name": "Ambien Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289072906",
      "ndc_label_name": "Ambien TABLET 5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024540131",
      "ndc_label_name": "Ambien Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036210",
      "ndc_label_name": "Ambien Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036220",
      "ndc_label_name": "Ambien Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036230",
      "ndc_label_name": "Ambien Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001710",
      "ndc_label_name": "Ambien TABLET 5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036260",
      "ndc_label_name": "Ambien Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713540101",
      "ndc_label_name": "Ambien Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289072930",
      "ndc_label_name": "Ambien TABLET 5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001730",
      "ndc_label_name": "Ambien TABLET 5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00469305130",
      "ndc_label_name": "AmBisome Suspension Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505455303",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378427193",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884035411",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710118003",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097038702",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794005208",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335023783",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591240630",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884035462",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009014230",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407059530",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651049530",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009014130",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591240530",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505455203",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378427093",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884035311",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794005108",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407059430",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710117903",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335023683",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884035362",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651049430",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097038602",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168027860",
      "ndc_label_name": "Amcinonide Cream 0.1 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "74157000660",
      "ndc_label_name": "Amcinonide Cream 0.1 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168027830",
      "ndc_label_name": "Amcinonide Cream 0.1 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168027815",
      "ndc_label_name": "Amcinonide Cream 0.1 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080055535",
      "ndc_label_name": "AMD Foam Dressing PAD 3-1/2\"X3\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840541002",
      "ndc_label_name": "American Beech Pollen Solution 1:20 Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840541004",
      "ndc_label_name": "American Beech Pollen Solution 1:20 Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840542605",
      "ndc_label_name": "American Elm (Diagnostic) Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840542602",
      "ndc_label_name": "American Elm Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779289405",
      "ndc_label_name": "American Ginseng POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779289404",
      "ndc_label_name": "American Ginseng POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779289403",
      "ndc_label_name": "American Ginseng POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779289406",
      "ndc_label_name": "American Ginseng POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779289408",
      "ndc_label_name": "American Ginseng POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840577205",
      "ndc_label_name": "American Lobster (Diagnostic) Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840547202",
      "ndc_label_name": "American Sycamore Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862004701",
      "ndc_label_name": "Amethia Tablet 0.15-0.03 &0.01 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862004791",
      "ndc_label_name": "Amethia Tablet 0.15-0.03 &0.01 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52544029528",
      "ndc_label_name": "Amethyst Tablet 90-20 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480347224",
      "ndc_label_name": "Amethyst Tablet 90-20 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52544029531",
      "ndc_label_name": "Amethyst TABLET 90-20 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49411005208",
      "ndc_label_name": "Amicar Solution 0.25 GM/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49411005130",
      "ndc_label_name": "Amicar Tablet 1000 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49411005030",
      "ndc_label_name": "Amicar Tablet 500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08214210001",
      "ndc_label_name": "Amielle Vaginal Trainer",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08470210001",
      "ndc_label_name": "Amielle Vaginal Trainer",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08214215001",
      "ndc_label_name": "Amielle Vaginal Trainer",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08470215001",
      "ndc_label_name": "Amielle Vaginal Trainer",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452001304",
      "ndc_label_name": "Amikacin Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779029509",
      "ndc_label_name": "Amikacin Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779029503",
      "ndc_label_name": "Amikacin Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000722",
      "ndc_label_name": "Amikacin Sulfate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779029505",
      "ndc_label_name": "Amikacin Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779029504",
      "ndc_label_name": "Amikacin Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452001306",
      "ndc_label_name": "Amikacin Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452001302",
      "ndc_label_name": "Amikacin Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927270400",
      "ndc_label_name": "Amikacin Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452001305",
      "ndc_label_name": "Amikacin Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991200204",
      "ndc_label_name": "Amikacin Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000725",
      "ndc_label_name": "Amikacin Sulfate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452001301",
      "ndc_label_name": "Amikacin Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000701",
      "ndc_label_name": "Amikacin Sulfate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000711",
      "ndc_label_name": "Amikacin Sulfate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991200201",
      "ndc_label_name": "Amikacin Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991200205",
      "ndc_label_name": "Amikacin Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991200202",
      "ndc_label_name": "Amikacin Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155029042",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 1 GM/4ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021017304",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 1 GM/4ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323081522",
      "ndc_label_name": "Amikacin Sulfate Solution 1 GM/4ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703904003",
      "ndc_label_name": "Amikacin Sulfate Solution 1 GM/4ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155078641",
      "ndc_label_name": "Amikacin Sulfate Solution 1 GM/4ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641616601",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 1 GM/4ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301002302",
      "ndc_label_name": "Amikacin Sulfate Solution 1 GM/4ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323081504",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 1 GM/4ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641616610",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 1 GM/4ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155029032",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 1 GM/4ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155078631",
      "ndc_label_name": "Amikacin Sulfate Solution 1 GM/4ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323081502",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 500 MG/2ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641616701",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 500 MG/2ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301002202",
      "ndc_label_name": "Amikacin Sulfate Solution 500 MG/2ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703903203",
      "ndc_label_name": "Amikacin Sulfate Solution 500 MG/2ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641616710",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 500 MG/2ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155029041",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 500 MG/2ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155029031",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 500 MG/2ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323081521",
      "ndc_label_name": "Amikacin Sulfate Solution 500 MG/2ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703903201",
      "ndc_label_name": "Amikacin Sulfate Solution 500 MG/2ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155078531",
      "ndc_label_name": "Amikacin Sulfate Solution 500 MG/2ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155078541",
      "ndc_label_name": "Amikacin Sulfate Solution 500 MG/2ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021017302",
      "ndc_label_name": "Amikacin Sulfate SOLUTION 500 MG/2ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452039701",
      "ndc_label_name": "AMILoride HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452039703",
      "ndc_label_name": "AMILoride HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452039702",
      "ndc_label_name": "AMILoride HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452039704",
      "ndc_label_name": "AMILoride HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927199300",
      "ndc_label_name": "AMILoride HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574029201",
      "ndc_label_name": "AMILoride HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629211401",
      "ndc_label_name": "aMILoride HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429027501",
      "ndc_label_name": "aMILoride HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884011710",
      "ndc_label_name": "AMILoride HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794000502",
      "ndc_label_name": "aMILoride HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884011701",
      "ndc_label_name": "AMILoride HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378057701",
      "ndc_label_name": "aMILoride-hydroCHLOROthiazide Tablet 5-50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378057705",
      "ndc_label_name": "aMILoride-hydroCHLOROthiazide Tablet 5-50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555048302",
      "ndc_label_name": "aMILoride-hydroCHLOROthiazide Tablet 5-50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090051301",
      "ndc_label_name": "aMILoride-hydroCHLOROthiazide Tablet 5-50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555048305",
      "ndc_label_name": "aMILoride-hydroCHLOROthiazide Tablet 5-50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70568600901",
      "ndc_label_name": "AminoAMrms Capsule Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452041003",
      "ndc_label_name": "Aminobenzoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452041001",
      "ndc_label_name": "Aminobenzoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452041002",
      "ndc_label_name": "Aminobenzoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452041004",
      "ndc_label_name": "Aminobenzoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991283501",
      "ndc_label_name": "Aminocaproic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779098907",
      "ndc_label_name": "Aminocaproic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452040903",
      "ndc_label_name": "Aminocaproic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779098908",
      "ndc_label_name": "Aminocaproic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779098904",
      "ndc_label_name": "Aminocaproic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991283503",
      "ndc_label_name": "Aminocaproic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991283502",
      "ndc_label_name": "Aminocaproic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779098905",
      "ndc_label_name": "Aminocaproic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991283504",
      "ndc_label_name": "Aminocaproic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779098909",
      "ndc_label_name": "Aminocaproic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452040902",
      "ndc_label_name": "Aminocaproic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452040901",
      "ndc_label_name": "Aminocaproic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052026505",
      "ndc_label_name": "Aminocaproic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552076305",
      "ndc_label_name": "Aminocaproic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927177600",
      "ndc_label_name": "Aminocaproic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452040904",
      "ndc_label_name": "Aminocaproic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052026501",
      "ndc_label_name": "Aminocaproic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552076307",
      "ndc_label_name": "Aminocaproic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817081508",
      "ndc_label_name": "Aminocaproic Acid Solution 0.25 GM/ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722003523",
      "ndc_label_name": "Aminocaproic Acid Solution 0.25 GM/ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478044708",
      "ndc_label_name": "Aminocaproic Acid Solution 0.25 GM/ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651057308",
      "ndc_label_name": "Aminocaproic Acid Solution 0.25 GM/ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054110058",
      "ndc_label_name": "Aminocaproic Acid Solution 0.25 GM/ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238159608",
      "ndc_label_name": "Aminocaproic Acid Solution 0.25 GM/ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315050324",
      "ndc_label_name": "Aminocaproic Acid Solution 0.25 GM/ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689033008",
      "ndc_label_name": "Aminocaproic Acid Solution 0.25 GM/ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80005013022",
      "ndc_label_name": "Aminocaproic Acid Solution 0.25 GM/ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69680011408",
      "ndc_label_name": "Aminocaproic Acid Solution 0.25 GM/ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377010411",
      "ndc_label_name": "Aminocaproic Acid Solution 0.25 GM/ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517912025",
      "ndc_label_name": "Aminocaproic Acid Solution 250 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517912001",
      "ndc_label_name": "Aminocaproic Acid Solution 250 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409434616",
      "ndc_label_name": "Aminocaproic Acid Solution 250 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517919125",
      "ndc_label_name": "Aminocaproic Acid Solution 250 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572001501",
      "ndc_label_name": "Aminocaproic Acid Solution 250 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409434673",
      "ndc_label_name": "Aminocaproic Acid Solution 250 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517919101",
      "ndc_label_name": "Aminocaproic Acid Solution 250 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572001525",
      "ndc_label_name": "Aminocaproic Acid Solution 250 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054111013",
      "ndc_label_name": "Aminocaproic Acid Tablet 1000 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315023203",
      "ndc_label_name": "Aminocaproic Acid Tablet 1000 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69680011630",
      "ndc_label_name": "Aminocaproic Acid Tablet 1000 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478076930",
      "ndc_label_name": "Aminocaproic Acid Tablet 1000 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658079930",
      "ndc_label_name": "Aminocaproic Acid Tablet 1000 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377010311",
      "ndc_label_name": "Aminocaproic Acid Tablet 1000 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315023103",
      "ndc_label_name": "Aminocaproic Acid Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478076830",
      "ndc_label_name": "Aminocaproic Acid Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904716507",
      "ndc_label_name": "Aminocaproic Acid Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658079830",
      "ndc_label_name": "Aminocaproic Acid Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377010211",
      "ndc_label_name": "Aminocaproic Acid Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687050525",
      "ndc_label_name": "Aminocaproic Acid Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687073925",
      "ndc_label_name": "Aminocaproic Acid Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205004930",
      "ndc_label_name": "Aminocaproic Acid Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687073995",
      "ndc_label_name": "Aminocaproic Acid Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687050595",
      "ndc_label_name": "Aminocaproic Acid Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559022530",
      "ndc_label_name": "Aminocaproic Acid Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238163703",
      "ndc_label_name": "Aminocaproic Acid Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69680011530",
      "ndc_label_name": "Aminocaproic Acid Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927507300",
      "ndc_label_name": "Aminolevulinic Acid HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144013801",
      "ndc_label_name": "Aminolevulinic Acid HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452043105",
      "ndc_label_name": "Aminophylline Anhydrous Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452043001",
      "ndc_label_name": "Aminophylline Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452043006",
      "ndc_label_name": "Aminophylline Anhydrous Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452043007",
      "ndc_label_name": "Aminophylline Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552031305",
      "ndc_label_name": "Aminophylline Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552157105",
      "ndc_label_name": "Aminophylline Anhydrous Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927144400",
      "ndc_label_name": "Aminophylline Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452043101",
      "ndc_label_name": "Aminophylline Anhydrous Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552157104",
      "ndc_label_name": "Aminophylline Anhydrous Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452043002",
      "ndc_label_name": "Aminophylline Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991200302",
      "ndc_label_name": "Aminophylline Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452043102",
      "ndc_label_name": "Aminophylline Anhydrous Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991200303",
      "ndc_label_name": "Aminophylline Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452043103",
      "ndc_label_name": "Aminophylline Anhydrous Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552031307",
      "ndc_label_name": "Aminophylline Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452043104",
      "ndc_label_name": "Aminophylline Anhydrous Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552031304",
      "ndc_label_name": "Aminophylline Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409592101",
      "ndc_label_name": "Aminophylline Solution 25 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409592216",
      "ndc_label_name": "Aminophylline Solution 25 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409592201",
      "ndc_label_name": "Aminophylline Solution 25 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409592116",
      "ndc_label_name": "Aminophylline Solution 25 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70568600401",
      "ndc_label_name": "AminoPMrms CAPSULE ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927500100",
      "ndc_label_name": "Aminopropyl Racementhyl Phos POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927160800",
      "ndc_label_name": "Aminosalicylic Acid-4 POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552132604",
      "ndc_label_name": "Aminosalicylic Acid-5 POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552132606",
      "ndc_label_name": "Aminosalicylic Acid-5 POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452045003",
      "ndc_label_name": "Aminosalicylic Acid-5 Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552132605",
      "ndc_label_name": "Aminosalicylic Acid-5 POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452045002",
      "ndc_label_name": "Aminosalicylic Acid-5 POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452045001",
      "ndc_label_name": "Aminosalicylic Acid-5 POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452045004",
      "ndc_label_name": "Aminosalicylic Acid-5 Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927107800",
      "ndc_label_name": "Aminosalicylic Acid-5 POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862024030",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291000930",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714084301",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629207601",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407087330",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42494030703",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009711",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382029706",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009715",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135057630",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672405506",
      "ndc_label_name": "Amiodarone HCl TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006030",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629929401",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907000530",
      "ndc_label_name": "Amiodarone HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185014405",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356000110",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300035905",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090301501",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300035916",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904699361",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382022714",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185014460",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781120392",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090576602",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090301502",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687043701",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135057760",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714084402",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672402502",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356000190",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714084401",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407087490",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739005110",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407087405",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862073205",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862073260",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518193901",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862024105",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090576601",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672402504",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003960",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862024160",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335088102",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518324600",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907000660",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687043711",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862024190",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382022705",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335194202",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335088104",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518193900",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003905",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407087530",
      "ndc_label_name": "Amiodarone HCl Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862024230",
      "ndc_label_name": "Amiodarone HCl Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42494030903",
      "ndc_label_name": "Amiodarone HCl Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714084501",
      "ndc_label_name": "Amiodarone HCl Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006130",
      "ndc_label_name": "Amiodarone HCl Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629200101",
      "ndc_label_name": "Amiodarone HCl Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672405700",
      "ndc_label_name": "Amiodarone HCl TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135057830",
      "ndc_label_name": "Amiodarone HCl Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672405706",
      "ndc_label_name": "Amiodarone HCl TABLET 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382029806",
      "ndc_label_name": "Amiodarone HCl Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23635052460",
      "ndc_label_name": "Amitiza Capsule 24 MCG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356050060",
      "ndc_label_name": "Amitiza Capsule 24 MCG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64764024060",
      "ndc_label_name": "Amitiza Capsule 24 MCG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629459801",
      "ndc_label_name": "Amitiza Capsule 24 MCG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64764008060",
      "ndc_label_name": "Amitiza Capsule 8 MCG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23635050860",
      "ndc_label_name": "Amitiza Capsule 8 MCG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455950703",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779018905",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455950702",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455950707",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455950701",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50488100400",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779018909",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455950706",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552046405",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779018908",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455950704",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452046002",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779018903",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60966022603",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779288301",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927160300",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60966012604",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452046004",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455950705",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452046005",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779018904",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991200403",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779288302",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307003039",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60966032602",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452046007",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779018902",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50488100401",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452046003",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307003005",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452046001",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68981001502",
      "ndc_label_name": "Amitriptyline HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60966042601",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000805",
      "ndc_label_name": "Amitriptyline HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552046404",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307003011",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552046402",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307003015",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50488100402",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457993602",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991200404",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68981001504",
      "ndc_label_name": "Amitriptyline HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552046406",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092999103",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000801",
      "ndc_label_name": "Amitriptyline HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307003025",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000822",
      "ndc_label_name": "Amitriptyline HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457993603",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68981001501",
      "ndc_label_name": "Amitriptyline HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092999101",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552046407",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420001724",
      "ndc_label_name": "Amitriptyline HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000825",
      "ndc_label_name": "Amitriptyline HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092999104",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991200402",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457993604",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68981001503",
      "ndc_label_name": "Amitriptyline HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420001712",
      "ndc_label_name": "Amitriptyline HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457993601",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70859001310",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70859001350",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092999102",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092999105",
      "ndc_label_name": "Amitriptyline HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781148610",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709085",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221221",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571010501",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709030",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781148601",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090302607",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571010510",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044602",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788007710",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221232",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044601",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709081",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090302600",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001130",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353030653",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017101",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041910",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017117",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041901",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788007701",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090617906",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919011760",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090617901",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000840",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090003006",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353030630",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090398601",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714025701",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090742401",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788821803",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090617907",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700064390",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090302606",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353030660",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760021290",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714025702",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090742407",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335039503",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268003711",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187063730",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090398606",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999020560",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760055690",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353030680",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407079310",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335963700",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000815",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788821809",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090617900",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090003000",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919011730",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090742406",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000820",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335963703",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000860",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518362101",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002049160",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090003001",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001860",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268003715",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000890",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425017202",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002049130",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122500",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700064330",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090302601",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367038801",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407079301",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289012412",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425038601",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289012430",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934033130",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629211601",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090398600",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122501",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000850",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664068788",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425038602",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629211501",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610075080",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001890",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090742400",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610075053",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002049100",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760055615",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000802",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788632006",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189043160",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788821806",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959000830",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006701",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664068718",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001190",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760021215",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788632009",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069360",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367038810",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001160",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069301",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518153800",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788632003",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610075060",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518153804",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425017201",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518153802",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518153801",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518153805",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610071030",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788632008",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610071080",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756020111",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610075030",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518153803",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189043190",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335963701",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069330",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756020112",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069390",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425038603",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804009230",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335963704",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008000390",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008000330",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610071053",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610071060",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006700",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709485",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221621",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709481",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356074130",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714026101",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709490",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054221",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090758302",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571010901",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268004111",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781149001",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054230",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760090790",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788008101",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054240",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122901",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017501",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054215",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714045001",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700066030",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919022390",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300042301",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367039201",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888007101",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090033302",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919022360",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090356402",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919022330",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788405208",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054242",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518150501",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425043903",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090641802",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788689903",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090398502",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788405203",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788689906",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664069088",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756020511",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788405206",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407079701",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788689908",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268004115",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788405209",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788838006",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629211701",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189058130",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069701",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054214",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335004001",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054228",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028702",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788838009",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788838003",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420023930",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069760",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267056090",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788838008",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760073290",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028703",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518150500",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425043901",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788689909",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425043902",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420023960",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420023990",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069730",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028701",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069790",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008004530",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008005830",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629211801",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571011001",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788008201",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221721",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781149101",
      "ndc_label_name": "Amitriptyline HCl TABLET 150 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300042401",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407079801",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714045101",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919037430",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714026201",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189058830",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069860",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919037445",
      "ndc_label_name": "Amitriptyline HCl TABLET 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518225800",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367039301",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664069188",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756020611",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017601",
      "ndc_label_name": "Amitriptyline HCl TABLET 150 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888007201",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518225801",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189062230",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710123001",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069890",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069801",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069830",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709130",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709185",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709160",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709194",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709181",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781148701",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781148710",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709190",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221321",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571010601",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709192",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221332",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709191",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12634040171",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714025802",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904718461",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904020161",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571010610",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016330",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788007810",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788007801",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714025801",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044702",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904741061",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044701",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016360",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090400500",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017201",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086330",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999006350",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017217",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086328",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300042001",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090400501",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631301",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631300",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016353",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090003108",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300042010",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090692501",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082230",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090400504",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090727300",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090692504",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090003100",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090284001",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090003104",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687043301",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090284008",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090727104",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090751300",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090727100",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090003101",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631308",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090284000",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919028930",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631304",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034850",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002033960",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268003815",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090400508",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034800",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090692500",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187040815",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090692508",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002033900",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664068818",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436307201",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407079410",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034830",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034812",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001991",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090692700",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760068590",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687043311",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436307202",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034890",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118211306",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034815",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788834601",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090727101",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919028990",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760083830",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407079401",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002033930",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788682506",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034860",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788834604",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090727108",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788834603",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187040814",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034802",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700060030",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335125404",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187040890",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335030602",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268003811",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788834606",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187040830",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034814",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664068888",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335963301",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629136910",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335963302",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436307205",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788834609",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267100600",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034820",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001914",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335963304",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788869103",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610069560",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034810",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518148400",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788834608",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700060090",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267001960",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610070353",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367038901",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610070360",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700060060",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610070330",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788869101",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760036730",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788682509",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006800",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122601",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189042060",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118211403",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028503",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518364101",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919028960",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788869104",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420023730",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335125406",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629211901",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118211406",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069401",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756020211",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629212001",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518408800",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425021203",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610075130",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788869106",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760036700",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425039502",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335239706",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788869109",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122600",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008000490",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189042030",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756020212",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187040860",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934007130",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610075153",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335125402",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335030604",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610069530",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006801",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789030530",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788682503",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425021201",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610075160",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028501",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335239703",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008000430",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425021202",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788682508",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610075180",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335963303",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425039503",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367038910",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189042090",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335963306",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804010030",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518148401",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420023790",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420023760",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028502",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425039501",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069430",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069460",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069490",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709230",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781148810",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709292",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714025902",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709281",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709291",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221421",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709294",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709260",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788007901",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044801",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016453",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571010701",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781148801",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714025901",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904020261",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709285",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063083630",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999022800",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016460",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571010710",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631502",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017317",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788007910",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709290",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090026400",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090759900",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090297200",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044802",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090718305",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300042110",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017301",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221432",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090026401",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268003911",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090718300",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300042101",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051410",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090026405",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090255301",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904718561",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090255305",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407079501",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090718301",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016430",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700061990",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631505",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631500",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904741161",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090759800",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760068690",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051420",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090026402",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788836303",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090759902",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631501",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090718302",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090759802",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629212101",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051421",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090255300",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788836308",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090759905",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687044411",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436371001",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090759805",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788836306",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051490",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090255302",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788876703",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436307302",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629898702",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001360",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090759901",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335249101",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700061960",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090759801",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788876706",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051400",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518163300",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919007630",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051401",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610075280",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629898703",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268003915",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756020311",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051460",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518163301",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187035930",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959051430",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006900",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367039001",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436307301",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756020312",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687044401",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610071160",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788706103",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664068988",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420023860",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122701",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407079510",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205082330",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919007690",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189044090",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788876708",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919007660",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008006990",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335036602",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700061930",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610075230",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187015530",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425043403",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518049301",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629898701",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629212201",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335125604",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664068918",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069501",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002060",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610071129",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069530",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788706109",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788706108",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425013701",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919024060",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425043402",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788876709",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425043401",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788706106",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788836309",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367039010",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335125602",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518163302",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335125603",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335963503",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189044030",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122700",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420023830",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335963504",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069590",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610075253",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610071130",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006901",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610075260",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420023890",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069560",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425036201",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008002730",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709385",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709330",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300042201",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709381",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571010801",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781148901",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788008001",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833901",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714044901",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603221521",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959028460",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714026001",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268004015",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268004011",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999090960",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833906",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729017401",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205046630",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664069288",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919054190",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407079601",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959028430",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760018130",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788878801",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959028400",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069630",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629212301",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788643201",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629359705",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788643208",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518397900",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788878806",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700068930",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008004330",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367039101",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788643203",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788643209",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833903",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189030930",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804004830",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833909",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833908",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788878803",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788643206",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788878808",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518257000",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069660",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122801",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788878809",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335017301",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069690",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756020411",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335239802",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189044430",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888007001",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420069601",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513048201",
      "ndc_label_name": "Amjevita Solution Auto-Injector 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513048202",
      "ndc_label_name": "Amjevita Solution Auto-Injector 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72511048201",
      "ndc_label_name": "Amjevita Solution Auto-Injector 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72511048202",
      "ndc_label_name": "Amjevita Solution Auto-Injector 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "84612048202",
      "ndc_label_name": "Amjevita Solution Auto-Injector 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513040001",
      "ndc_label_name": "Amjevita Solution Auto-Injector 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72511040001",
      "ndc_label_name": "Amjevita Solution Auto-Injector 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090642800",
      "ndc_label_name": "Amjevita Solution Auto-Injector 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513040002",
      "ndc_label_name": "Amjevita Solution Auto-Injector 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72511040002",
      "ndc_label_name": "Amjevita Solution Auto-Injector 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72511048102",
      "ndc_label_name": "Amjevita Solution Auto-Injector 80 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513048101",
      "ndc_label_name": "Amjevita Solution Auto-Injector 80 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "84612048102",
      "ndc_label_name": "Amjevita Solution Auto-Injector 80 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72511048101",
      "ndc_label_name": "Amjevita Solution Auto-Injector 80 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513048102",
      "ndc_label_name": "Amjevita Solution Auto-Injector 80 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72511047902",
      "ndc_label_name": "Amjevita Solution Prefilled Syringe 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72511047901",
      "ndc_label_name": "Amjevita Solution Prefilled Syringe 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513047901",
      "ndc_label_name": "Amjevita Solution Prefilled Syringe 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "84612047902",
      "ndc_label_name": "Amjevita Solution Prefilled Syringe 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513047902",
      "ndc_label_name": "Amjevita Solution Prefilled Syringe 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090641100",
      "ndc_label_name": "Amjevita Solution Prefilled Syringe 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513041001",
      "ndc_label_name": "Amjevita Solution Prefilled Syringe 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513041301",
      "ndc_label_name": "Amjevita-Ped 10kg to <15kg Solution Prefilled Syringe 10 MG/0.2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513039901",
      "ndc_label_name": "Amjevita-Ped 15kg to <30kg Solution Prefilled Syringe 20 MG/0.2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "84612039901",
      "ndc_label_name": "Amjevita-Ped 15kg to <30kg Solution Prefilled Syringe 20 MG/0.2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72511039901",
      "ndc_label_name": "Amjevita-Ped 15kg to <30kg Solution Prefilled Syringe 20 MG/0.2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513041101",
      "ndc_label_name": "Amjevita-Ped 15kg to <30kg Solution Prefilled Syringe 20 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052000550",
      "ndc_label_name": "Amlexanox Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052000501",
      "ndc_label_name": "Amlexanox Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552143903",
      "ndc_label_name": "AmLODIPine Bes+SyrSpend SF Suspension 1 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440714390",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440714330",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440714385",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090736100",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440714381",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090141800",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090141801",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111034101",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090736101",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237014601",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090513701",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919085290",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291001401",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862058601",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862058605",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518256600",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111034105",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189026090",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090642700",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090513700",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001013000",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788845403",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788881803",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090642701",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788816803",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180047201",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789028501",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789041290",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789050290",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090272000",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862058701",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155092501",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001013100",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090146300",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090538900",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291001501",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090328500",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237014701",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180047301",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862058705",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111058601",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "84677001301",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111033801",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 2.5-10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001013200",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 2.5-10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440714030",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 2.5-10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862058201",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 2.5-10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237014201",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 2.5-10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180075501",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 2.5-10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440714081",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 2.5-10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440714085",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 2.5-10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440714090",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 2.5-10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440714185",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440714190",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440714130",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237014301",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001013300",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291001101",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440714181",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518192800",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518330300",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090540400",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111033905",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862058301",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090103900",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111033901",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180075601",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090677000",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518242100",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862058305",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789043290",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291001201",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440714281",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090428400",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090104101",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440714230",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440714290",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090428401",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090618500",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862058401",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111034001",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237014401",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090104201",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440714285",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090104200",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001013400",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862058405",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111034005",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205012230",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180045901",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162236001",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090618501",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291001301",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090535700",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090304900",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862058501",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090340400",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111058701",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862058505",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090164400",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237014501",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180046301",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001013500",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090335700",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518303000",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779251509",
      "ndc_label_name": "AmLODIPine Besylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452042902",
      "ndc_label_name": "AmLODIPine Besylate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779251505",
      "ndc_label_name": "AmLODIPine Besylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779251504",
      "ndc_label_name": "AmLODIPine Besylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552143805",
      "ndc_label_name": "AmLODIPine Besylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779273409",
      "ndc_label_name": "AmLODIPine Besylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779273404",
      "ndc_label_name": "AmLODIPine Besylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779273405",
      "ndc_label_name": "AmLODIPine Besylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452042904",
      "ndc_label_name": "AmLODIPine Besylate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452042903",
      "ndc_label_name": "AmLODIPine Besylate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779251508",
      "ndc_label_name": "AmLODIPine Besylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779273408",
      "ndc_label_name": "AmLODIPine Besylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68981001601",
      "ndc_label_name": "amLODIPine Besylate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68981001602",
      "ndc_label_name": "amLODIPine Besylate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452042901",
      "ndc_label_name": "AmLODIPine Besylate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552143803",
      "ndc_label_name": "AmLODIPine Besylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927426100",
      "ndc_label_name": "AmLODIPine Besylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927440400",
      "ndc_label_name": "AmLODIPine Besylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509890",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480716810",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709885",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509800",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509885",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509830",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904637161",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509805",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300039805",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135076190",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709890",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024310",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709881",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709830",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024319",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509860",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090535400",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582031509",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135076110",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063004190",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052603",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024305",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300039819",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509881",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090535401",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063004130",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291002710",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353053445",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052610",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300039810",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582031518",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480716898",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090555000",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353053430",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090258102",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353069130",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291002790",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353053460",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353098930",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052605",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407095110",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353069160",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407095190",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090152901",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806005709",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353098960",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090680800",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052690",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111027190",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090258101",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664057099",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090535402",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806005710",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090152900",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090680801",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806005705",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762213509",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760045930",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762213501",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090680900",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353098945",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700054130",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664005718",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071070730",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760013290",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760045990",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687049601",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959020990",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090258100",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919078230",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664005799",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071134900",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877019905",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187032690",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687049611",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919046030",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090680802",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919080530",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760044530",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645051654",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680506",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518263201",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760013230",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919080590",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664005713",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877019990",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919046090",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788638601",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335021803",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934033090",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187091430",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010305",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664057013",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788638609",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877019910",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788798509",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335079901",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050690",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010399",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010390",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664057018",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788798503",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788638606",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788854309",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610046953",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335021801",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645058054",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072103",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760061430",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788798506",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680501",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097012805",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610062035",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335079902",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788798501",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072109",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919078290",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097083805",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788845101",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584002390",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789026260",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335094503",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788854301",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680503",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187091490",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097083815",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788845106",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584002393",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804097155",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335186501",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518263200",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788845109",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544099331",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69150011510",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584002350",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050630",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804097172",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610046945",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518263203",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788854306",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382012305",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934006730",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934033030",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335094506",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382012316",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610046960",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335021805",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584002309",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788638603",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335094501",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71093014803",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610093845",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680509",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610062060",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335094504",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71093014806",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788845103",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610062080",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205048890",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789026230",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788854303",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610092830",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335094507",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335021804",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097012815",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610092853",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335021802",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282050910",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518263202",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789026295",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610046930",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335186502",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335094502",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789051690",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610092845",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804097100",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335094505",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789051630",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610062030",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610083060",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789026290",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789051695",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282023990",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610093830",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282050990",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282023910",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610062045",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804097190",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804097130",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009002810",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610083030",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804016490",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804097160",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008003990",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610083045",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804097111",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610093853",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008003930",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610093860",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189052930",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189052990",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480008305",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509681",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509630",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052403",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509600",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509605",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709630",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709681",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052405",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480008398",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052410",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052490",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509660",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904636961",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709685",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709690",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024119",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024105",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135075910",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090162701",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509685",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582031309",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135075990",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664056899",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582031318",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300039605",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024110",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919075390",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300039619",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959091090",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300039610",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788725901",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806005510",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806005509",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664005513",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187078310",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291002510",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010190",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090685300",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788767909",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063076430",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090162702",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877019710",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187078390",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806005505",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877090090",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111026990",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71093014603",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664056813",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090162703",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180023302",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180023301",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762224203",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788725909",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664005599",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584002150",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187078330",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664005518",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382012105",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789026090",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010199",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788767903",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762224209",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096960",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010105",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877019705",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788826306",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788826309",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877019790",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097012615",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788725906",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69150011310",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180071909",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71093014605",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097083605",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008230",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382012116",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610073260",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788767906",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789051495",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788725903",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282023710",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097083615",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096911",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789026095",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788826301",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788767901",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518197100",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282023790",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097012605",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788826303",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335083302",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282050710",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584002109",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610073215",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610073253",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096900",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584002190",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096930",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282050790",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096955",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518197101",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096990",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096972",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610053560",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610073230",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610073245",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009002610",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009002690",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509790",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509781",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509705",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709730",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509700",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052590",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509730",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480716710",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024219",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904637061",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709785",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709781",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440709790",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024205",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509760",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806005610",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300039719",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052510",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135076010",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300039705",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052503",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806005609",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440509785",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090252402",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582031418",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300039710",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135076090",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090152700",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582031409",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353025160",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480716798",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664005613",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353025130",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356074010",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024210",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090505900",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806005605",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353068430",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135052505",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919084460",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090287600",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291002610",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356005930",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090687601",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353025115",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090152701",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353025145",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919084471",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959091190",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056490",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356005960",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090687700",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353054545",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071134800",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353068415",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788693506",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700054330",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090687602",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056430",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407095010",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700054390",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382012216",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090252400",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788862709",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762201001",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959091130",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353068445",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919029571",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664005618",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680301",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090252401",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518027401",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687048801",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762201003",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353068460",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919084490",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664056999",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788693503",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090687600",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047305",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010299",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072003",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407095090",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877019805",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919029530",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788831309",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51655005225",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610068730",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071072830",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788862701",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687048811",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180045501",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010290",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205059630",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664005699",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610068745",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680303",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097012715",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010205",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072009",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788693501",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335235902",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664056913",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610069160",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680306",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518298101",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877019810",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382012205",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097083705",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610069145",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762201009",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610072215",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788680309",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934007530",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645051554",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788831301",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69150011490",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610088860",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919081460",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610088815",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097012705",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205059690",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788693509",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788831306",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518037601",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282023810",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919084430",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789051595",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518027400",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205059930",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584002209",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788862703",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047307",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804097060",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877019890",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282050810",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518083502",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610068715",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584002250",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788862706",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610072245",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804097090",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180045502",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804097030",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518191400",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610069130",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934007590",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584002295",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282023890",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789026190",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788831303",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518037602",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518298103",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789051590",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934028830",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789026160",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008003530",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097083715",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047301",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71093014703",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047303",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584002290",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047304",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71093014706",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610072230",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518037600",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189052030",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047306",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189052090",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518298100",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804097000",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610053960",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804097011",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518298102",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610072260",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205059990",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610088830",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335047302",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610095645",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335083402",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789051530",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610088845",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009002710",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789026130",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804097055",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789026195",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804097072",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282050890",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332020690",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-160 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155084503",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43386008203",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862073990",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378172293",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-160 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342028007",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407077330",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155084509",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862073930",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-160 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342028010",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180076506",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332020630",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-160 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43386008209",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-160 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155084703",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332020890",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-320 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407077430",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378172493",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-320 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332020830",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-320 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155084709",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43386008009",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-320 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862074090",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342028207",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342028210",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180076706",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090320900",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43386008003",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090247100",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862074030",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-320 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342027910",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378172193",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-160 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180076406",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43386008303",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-160 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332020530",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-160 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862073730",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-160 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155084403",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342027907",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155084409",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407077130",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862073790",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43386008309",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-160 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332020590",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-160 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155084603",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332020730",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-320 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43386008103",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342028107",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378172393",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-320 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342028110",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155084609",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862073830",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-320 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407077230",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862073890",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332020790",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-320 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180076606",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762673001",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332076230",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598032190",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378451793",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598032130",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505347903",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 10-10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335292401",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993027030",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162208903",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993027130",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762673101",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031890",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-20 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378451893",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-20 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162209003",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332076330",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031830",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-20 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505348403",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 10-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378451993",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-40 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031590",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-40 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162209103",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332076430",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762673201",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031530",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-40 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993027230",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505348903",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 10-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762673301",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332076530",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031330",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-80 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993027330",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 10-80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378452093",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 10-80 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505349303",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 10-80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598032330",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 2.5-10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762671001",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 2.5-10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332075530",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 2.5-10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993026330",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 2.5-10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993026430",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 2.5-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598032030",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 2.5-20 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762671101",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 2.5-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332075630",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 2.5-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993026530",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 2.5-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762671201",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 2.5-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031730",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 2.5-40 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332075730",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 2.5-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598032230",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505347803",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 5-10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378451393",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993026630",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162209203",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332075830",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598032290",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762672001",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162209303",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378451493",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-20 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505348303",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 5-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762672101",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332075930",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031930",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-20 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993026730",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031990",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-20 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031630",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-40 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031690",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-40 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505348803",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 5-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993026830",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378451593",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-40 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762672201",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332076030",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162209403",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762672301",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378451693",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-80 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505349203",
      "ndc_label_name": "Amlodipine-Atorvastatin Tablet 5-80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332076130",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598031430",
      "ndc_label_name": "Amlodipine-Atorvastatin TABLET 5-80 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993026930",
      "ndc_label_name": "amLODIPine-Atorvastatin Tablet 5-80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571023630",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342019207",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722044730",
      "ndc_label_name": "amLODIPine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462056730",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241008503",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668031230",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668031290",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342019210",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241008509",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664077399",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862085630",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571023690",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722044790",
      "ndc_label_name": "amLODIPine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407085830",
      "ndc_label_name": "amLODIPine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332021490",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332021430",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291000330",
      "ndc_label_name": "amLODIPine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877050030",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462056790",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664077383",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877050090",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668031130",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241008603",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668031190",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241008609",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877050290",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332021530",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722044830",
      "ndc_label_name": "amLODIPine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342019307",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462056930",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722044890",
      "ndc_label_name": "amLODIPine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342019310",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664077583",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862085730",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332021590",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571023890",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877050230",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291000430",
      "ndc_label_name": "amLODIPine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664077599",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571023830",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462056990",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407086030",
      "ndc_label_name": "amLODIPine-Olmesartan Tablet 10-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722044590",
      "ndc_label_name": "amLODIPine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342019007",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668032430",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668032490",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241008303",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241008309",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291000130",
      "ndc_label_name": "amLODIPine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342019010",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571023590",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664077299",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462056630",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571023530",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722044530",
      "ndc_label_name": "amLODIPine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332021230",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162237903",
      "ndc_label_name": "amLODIPine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332021290",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407085730",
      "ndc_label_name": "amLODIPine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877049930",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162237909",
      "ndc_label_name": "amLODIPine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877049990",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664077283",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862085430",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462056690",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664077483",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407085930",
      "ndc_label_name": "amLODIPine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668031390",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241008403",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332021330",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241008409",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332021390",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668031330",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862085530",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462056890",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571023730",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342019107",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877050130",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722044630",
      "ndc_label_name": "amLODIPine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664077499",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722044690",
      "ndc_label_name": "amLODIPine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462056830",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571023790",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342019110",
      "ndc_label_name": "Amlodipine-Olmesartan TABLET 5-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291000230",
      "ndc_label_name": "amLODIPine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877050190",
      "ndc_label_name": "Amlodipine-Olmesartan Tablet 5-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407067030",
      "ndc_label_name": "amLODIPine-Valsartan-HCTZ Tablet 10-160-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380019901",
      "ndc_label_name": "amLODIPine-Valsartan-HCTZ Tablet 10-160-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342028407",
      "ndc_label_name": "amLODIPine-Valsartan-HCTZ Tablet 10-160-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862083630",
      "ndc_label_name": "amLODIPine-Valsartan-HCTZ Tablet 10-160-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862083730",
      "ndc_label_name": "amLODIPine-Valsartan-HCTZ Tablet 10-160-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407067130",
      "ndc_label_name": "amLODIPine-Valsartan-HCTZ Tablet 10-160-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380020001",
      "ndc_label_name": "amLODIPine-Valsartan-HCTZ Tablet 10-160-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342028607",
      "ndc_label_name": "amLODIPine-Valsartan-HCTZ Tablet 10-160-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342028707",
      "ndc_label_name": "amLODIPine-Valsartan-HCTZ Tablet 10-320-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380020101",
      "ndc_label_name": "amLODIPine-Valsartan-HCTZ Tablet 10-320-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407067230",
      "ndc_label_name": "amLODIPine-Valsartan-HCTZ Tablet 10-320-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862083830",
      "ndc_label_name": "amLODIPine-Valsartan-HCTZ Tablet 10-320-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407066830",
      "ndc_label_name": "amLODIPine-Valsartan-HCTZ Tablet 5-160-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342028307",
      "ndc_label_name": "amLODIPine-Valsartan-HCTZ Tablet 5-160-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380019701",
      "ndc_label_name": "amLODIPine-Valsartan-HCTZ Tablet 5-160-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862083430",
      "ndc_label_name": "amLODIPine-Valsartan-HCTZ Tablet 5-160-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380019801",
      "ndc_label_name": "amLODIPine-Valsartan-HCTZ Tablet 5-160-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342028507",
      "ndc_label_name": "amLODIPine-Valsartan-HCTZ Tablet 5-160-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407066930",
      "ndc_label_name": "amLODIPine-Valsartan-HCTZ Tablet 5-160-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862083530",
      "ndc_label_name": "amLODIPine-Valsartan-HCTZ Tablet 5-160-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "40028051450",
      "ndc_label_name": "Ammonia N 13 Solution 3.75-260 MCI/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927167500",
      "ndc_label_name": "Ammonium Bromide GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927499100",
      "ndc_label_name": "Ammonium Bromide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452001403",
      "ndc_label_name": "Ammonium Carbonate (Bulk) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452001401",
      "ndc_label_name": "Ammonium Carbonate (Bulk) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452001402",
      "ndc_label_name": "Ammonium Carbonate (Bulk) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452052002",
      "ndc_label_name": "Ammonium Chloride Granules",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452052003",
      "ndc_label_name": "Ammonium Chloride Granules",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552051404",
      "ndc_label_name": "Ammonium Chloride GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552051405",
      "ndc_label_name": "Ammonium Chloride GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452052001",
      "ndc_label_name": "Ammonium Chloride Granules",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927118900",
      "ndc_label_name": "Ammonium Chloride GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452054003",
      "ndc_label_name": "Ammonium Hydroxide SOLUTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452054001",
      "ndc_label_name": "Ammonium Hydroxide SOLUTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927131800",
      "ndc_label_name": "Ammonium Hydroxide SOLUTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904598426",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71399014004",
      "ndc_label_name": "Ammonium Lactate Lotion 12 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802052555",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802041926",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672130009",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162140704",
      "ndc_label_name": "Ammonium Lactate Lotion 12 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904598463",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802052526",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72162140702",
      "ndc_label_name": "Ammonium Lactate Lotion 12 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672130005",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63044048409",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71399014008",
      "ndc_label_name": "Ammonium Lactate Lotion 12 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802041954",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090658700",
      "ndc_label_name": "Ammonium Lactate Lotion 12 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629861001",
      "ndc_label_name": "Ammonium Lactate Lotion 12 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629861101",
      "ndc_label_name": "Ammonium Lactate Lotion 12 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927176700",
      "ndc_label_name": "Ammonium Lactate SOLUTION 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927243700",
      "ndc_label_name": "Ammonium Lauryl Sulfate Liquid 28 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991298802",
      "ndc_label_name": "Ammonium Molybdate Tetrahyd POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452001501",
      "ndc_label_name": "Ammonium Molybdate Tetrahyd POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452001502",
      "ndc_label_name": "Ammonium Molybdate Tetrahyd POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927329100",
      "ndc_label_name": "Ammonium Molybdate Tetrahyd POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452001503",
      "ndc_label_name": "Ammonium Molybdate Tetrahyd POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927198400",
      "ndc_label_name": "Ammonium Molybdate Tetrahyd POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452058502",
      "ndc_label_name": "Ammonium Phosphate Dibasic GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452058501",
      "ndc_label_name": "Ammonium Phosphate Dibasic GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452058503",
      "ndc_label_name": "Ammonium Phosphate Dibasic GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452060003",
      "ndc_label_name": "Ammonium Sulfate GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452060001",
      "ndc_label_name": "Ammonium Sulfate GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927193600",
      "ndc_label_name": "Ammonium Sulfate GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452060002",
      "ndc_label_name": "Ammonium Sulfate GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00187001050",
      "ndc_label_name": "Ammonul Solution 10-10 % Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378661185",
      "ndc_label_name": "Amnesteem CAPSULE 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378661193",
      "ndc_label_name": "Amnesteem CAPSULE 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378661285",
      "ndc_label_name": "Amnesteem CAPSULE 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378661293",
      "ndc_label_name": "Amnesteem CAPSULE 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378661393",
      "ndc_label_name": "Amnesteem Capsule 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378661385",
      "ndc_label_name": "Amnesteem Capsule 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378661493",
      "ndc_label_name": "Amnesteem CAPSULE 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378661485",
      "ndc_label_name": "Amnesteem CAPSULE 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135070290",
      "ndc_label_name": "Amoxapine Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591571501",
      "ndc_label_name": "Amoxapine Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135070330",
      "ndc_label_name": "Amoxapine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591571630",
      "ndc_label_name": "Amoxapine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591571301",
      "ndc_label_name": "Amoxapine Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135070090",
      "ndc_label_name": "Amoxapine Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591571401",
      "ndc_label_name": "Amoxapine Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135070190",
      "ndc_label_name": "Amoxapine Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993041882",
      "ndc_label_name": "Amoxicill-Clarithro-Lansopraz Therapy Pack 500 & 500 & 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781405442",
      "ndc_label_name": "Amoxicill-Clarithro-Lansopraz Therapy Pack 500 & 500 & 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237000114",
      "ndc_label_name": "Amoxicill-Clarithro-Lansopraz Therapy Pack 500 & 500 & 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781405432",
      "ndc_label_name": "Amoxicill-Clarithro-Lansopraz Therapy Pack 500 & 500 & 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237000101",
      "ndc_label_name": "Amoxicill-Clarithro-Lansopraz Therapy Pack 500 & 500 & 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993041864",
      "ndc_label_name": "Amoxicill-Clarithro-Lansopraz Therapy Pack 500 & 500 & 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063057421",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710030",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710006",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710009",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710003",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093310701",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959001124",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093310705",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090028800",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781202005",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781202001",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063057406",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781202076",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029801",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002115",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710004",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090182601",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999001604",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582021310",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436721803",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029802",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063057404",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788824003",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959001121",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001915",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959001160",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090182600",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959001140",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582021318",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063057415",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508022505",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959001130",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001960",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003001",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001906",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002020830",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063057430",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001924",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003005",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348054530",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788781203",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001605",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135082401",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001930",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959001120",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788636902",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934015494",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788824002",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001921",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289001940",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007404",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518218800",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687077601",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002121",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007701",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934040721",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687077611",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629422601",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001601",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788636903",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934008730",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508022501",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007406",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007430",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007782",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056360",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710109",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093310906",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710130",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093310905",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143993905",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710103",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093310901",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082015",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056330",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029904",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056306",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710106",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710104",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781261305",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093310953",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082020",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082008",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082014",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056309",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571023401",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781261301",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781261376",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582021410",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082021",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082028",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999001520",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056328",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056308",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029902",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030101",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056315",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082040",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082030",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030107",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056340",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056314",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029903",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030204",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082004",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030100",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063091530",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151207",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056363",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056356",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571023405",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090181001",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082056",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151105",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151101",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151301",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082006",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082050",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42582021418",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090181105",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030105",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151204",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179400",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179505",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999001508",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030102",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063056321",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090181107",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030400",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179401",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090181300",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179601",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999001542",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030207",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999001506",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090181201",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151100",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179407",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002000",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090181005",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999001545",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030301",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030205",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002005",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151102",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090181104",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021642",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090318700",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030206",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179405",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030300",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002024",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151205",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090181200",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002004",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002060",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151206",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179506",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151107",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348055006",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179402",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002020",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002009",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021621",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151400",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179600",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090151300",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001660",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179700",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002040",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002014",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348055030",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179504",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090181106",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090179507",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919066621",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090181000",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021615",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002028",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002024",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002028",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002018",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090181002",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187039910",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002004",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021640",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002060",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002030",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002015",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021660",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51655089452",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187039940",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002006",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002006",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919099430",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002040",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002056",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001630",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002021",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788714103",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002030",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002050",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629758401",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002063",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003101",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135082560",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348055021",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788714104",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002042",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687078711",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002304",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003105",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687078701",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788851903",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002021",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788851904",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021630",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919035520",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002309",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919066610",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187039921",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789022582",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001620",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788897202",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021656",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919035530",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820904",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187039920",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629426501",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789025460",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187039914",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219000",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289002042",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919099420",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788897204",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187039960",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001701",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135082505",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187039930",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219003",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187004430",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629421601",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219001",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001705",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003321",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629421701",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267076404",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219006",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629421801",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002308",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003394",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003330",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005421",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820902",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788637403",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050721",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788714102",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820903",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005430",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050730",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005493",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219002",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788851902",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508020501",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788897203",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219005",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005440",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205081720",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005494",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420054550",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518323401",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007530",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219004",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789025430",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050740",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420019221",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205081730",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425026901",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003320",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020505",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219007",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205081721",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007510",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003392",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518323400",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007801",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518329400",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005492",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003393",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789025421",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050720",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050714",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508020505",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420050850",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007520",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007882",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020501",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781603946",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988880",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988815",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135077642",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090040400",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988801",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781603958",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781603955",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090679100",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999019100",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788994901",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187020015",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090300500",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959018180",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090040600",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999019180",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959018100",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021493",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959018108",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070601",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205026615",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135077668",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135077638",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090605600",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070655",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788830401",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205026680",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788901901",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070680",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959018101",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959084301",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007050",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093416076",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988650",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988601",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093416078",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093416073",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988675",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788832401",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788885201",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781615652",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919039932",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781615646",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781615657",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003201",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090426000",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007001",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003250",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007075",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788732301",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003275",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919067232",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788861101",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093415573",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093415580",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999016800",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988915",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988980",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093415579",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999016880",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090634900",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070755",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635100",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090180700",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781604158",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090041100",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988901",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090646900",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070701",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267099315",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919071633",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788875901",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090040700",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002020993",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781604146",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002020991",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071152608",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788994801",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135077742",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788901701",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187088015",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001533",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781604155",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135077738",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420057315",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135077768",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070780",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187018615",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420057310",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267099400",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090040500",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804013415",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420057380",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090225100",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631900",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090646600",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781615757",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093416176",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988775",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988750",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090134700",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090632300",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788873101",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093416173",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635500",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781615752",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189028532",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919040132",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007175",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090668000",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189038532",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093416178",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187026200",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090108600",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020750",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187026250",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788832501",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003301",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007150",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988701",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788901801",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959029605",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788903501",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788731801",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205043600",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919063375",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205042200",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781615746",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020751",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788873001",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090085800",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020752",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003350",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003375",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007101",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687079825",
      "ndc_label_name": "Amoxicillin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093226301",
      "ndc_label_name": "Amoxicillin TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237002801",
      "ndc_label_name": "Amoxicillin TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687079895",
      "ndc_label_name": "Amoxicillin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090070900",
      "ndc_label_name": "Amoxicillin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090182500",
      "ndc_label_name": "Amoxicillin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781506020",
      "ndc_label_name": "Amoxicillin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001401",
      "ndc_label_name": "Amoxicillin TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934014730",
      "ndc_label_name": "Amoxicillin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518322800",
      "ndc_label_name": "Amoxicillin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001405",
      "ndc_label_name": "Amoxicillin TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143928501",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093226401",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090071102",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090586302",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090071100",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781506101",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090071401",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710220",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143928520",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090071301",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090159601",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959066130",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090071302",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781506120",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090159500",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710230",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090071300",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090586301",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002001320",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237002901",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436454301",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090071400",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090159502",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063088520",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090159600",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919036620",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187032520",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788835202",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687080918",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090159501",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090588000",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090071200",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090586300",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219102",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862001501",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518141301",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919004120",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090588001",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959066120",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788716002",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919013520",
      "ndc_label_name": "Amoxicillin TABLET 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189046320",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219101",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219100",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187001320",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436002901",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687080928",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934006414",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629423701",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237002920",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003891",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219103",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205003520",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187032514",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420000320",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934006491",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804020020",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267130902",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003894",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789022401",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518219104",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934006494",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003814",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205003514",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789038814",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420013820",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093226701",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063034104",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289018220",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090045400",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710503",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710504",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710509",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093226801",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090045500",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959024621",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710530",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090045401",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289018290",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999003300",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959024640",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710514",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289018214",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919042430",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289018209",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959024619",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934014030",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090045405",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289018240",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959024630",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934014040",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629426301",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289018206",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289018230",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991200506",
      "ndc_label_name": "Amoxicillin Trihydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779242107",
      "ndc_label_name": "Amoxicillin Trihydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991200505",
      "ndc_label_name": "Amoxicillin Trihydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991200507",
      "ndc_label_name": "Amoxicillin Trihydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964022028",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate ER Tablet Extended Release 12 Hour 1000-62.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781194339",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate ER Tablet Extended Release 12 Hour 1000-62.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781194382",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate ER Tablet Extended Release 12 Hour 1000-62.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964022040",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate ER Tablet Extended Release 12 Hour 1000-62.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053375",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781610252",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919039332",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093227773",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781610246",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053350",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998175",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998150",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053301",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029202",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788830601",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685101101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029203",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781610257",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571016347",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788899601",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999035600",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788800001",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090622200",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452033443",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090083200",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685101100",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090593200",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651002675",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432006547",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651002601",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651002655",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097009843",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097009808",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043001001",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043001003",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432006500",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043001002",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020410",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097009844",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432006575",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020407",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020415",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998275",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781610452",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090304700",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029302",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090587300",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781610457",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998250",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093227973",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781610446",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090092800",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090330900",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053450",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090083100",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029303",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029301",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090638100",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090669400",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788831801",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685101200",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452033543",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187082600",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571016447",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053475",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685101201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919039132",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712801",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043000903",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205046250",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043000901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205046200",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788830501",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043000902",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685101202",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985324",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985316",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093867574",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788815707",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029403",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093867575",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985375",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781613957",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781613954",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029402",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781613948",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788829901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187085712",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093867578",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053575",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090185700",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090329300",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090099600",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205003612",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919069334",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788877007",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205003675",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187085775",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712707",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090221900",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508020351",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053513",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187085720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020354",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508020354",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788997001",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788815701",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788877001",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712701",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788829907",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788997007",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043000803",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508020369",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804001712",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043000802",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020369",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205062075",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043000801",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020351",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571016030",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 250-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781187431",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 250-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420050330",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 250-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714047601",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 250-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687078111",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 250-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162243503",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 250-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029501",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 250-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687078194",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 250-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862050130",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 250-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335289601",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 250-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781183101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571016142",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710703",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714049401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710704",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710730",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090254703",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093227434",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029601",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090254701",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090082000",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090082001",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090254702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090460401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070220",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781183120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598020614",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002023920",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090082003",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090699700",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070212",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090460403",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070230",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714047701",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090082002",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187003221",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070215",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070204",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070240",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070209",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687079211",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571016101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090254700",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629423901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788799802",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289084520",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289084530",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289084506",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187080320",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070214",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090460400",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267100101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518262500",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788706702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687079201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001920",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005314",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788796502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090460402",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685100202",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518262501",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518218904",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187003206",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071006330",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005394",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452033611",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070221",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518218902",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205001420",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518262503",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071154502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788830802",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189028114",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005714",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289084521",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518262502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420050720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335273501",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788831702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189063814",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289084528",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934012630",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518218905",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205001421",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135046220",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335282401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005794",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162221002",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862050220",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162243301",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789053321",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162243302",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071006306",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189028120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789053330",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205001406",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335299901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789041814",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143924920",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710804",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714047802",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710802",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714001402",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710830",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029701",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093227534",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710803",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440710820",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571016201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781185201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063007706",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12634080771",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063007703",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714001401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781185220",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090082101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090632401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598022114",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090082200",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090082202",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714047801",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090082100",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090082102",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090632402",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063007704",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090652900",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090082203",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090317900",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571016242",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090082105",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090317903",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070760",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090082103",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090741500",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090317905",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090317902",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063037702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090632400",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436100101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687080311",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090082201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919002020",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090652903",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090341400",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090231405",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289076728",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436312901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267085903",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090317901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919043014",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070714",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090441300",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090632403",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687080301",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222505",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090652902",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222507",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289076710",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090441301",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090652901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187042314",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070730",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003991",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070710",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518226300",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289076730",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070715",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090700300",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629454101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002078920",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508022114",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919052120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518226301",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919002014",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919043020",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289076720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862050301",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289076714",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014704",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919066514",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518232502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187001420",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187048814",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919020220",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267071230",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289076721",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014730",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187001414",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003994",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187042328",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919066520",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685100100",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919020210",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420000520",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187042310",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934008620",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267071221",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788835502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135046320",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071422402",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919063720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420050120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862050320",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205071920",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267100201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222500",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187042320",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071496702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187032720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964022114",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685100101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162243401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788830702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518226302",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187048820",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788827102",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788931902",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804017720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788828302",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014703",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222501",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518232500",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267071203",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222504",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934011091",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518232501",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788883602",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425021701",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222508",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003910",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267071210",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518226304",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934011094",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008304",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425027902",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205033114",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425018001",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267085904",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518226305",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205071220",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964022101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518226303",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518232503",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205065120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007601",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071154602",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008314",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205071914",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014714",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518226308",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014728",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008303",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804020120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788795802",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335291701",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934003914",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008306",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452033711",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014710",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205033120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008328",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222503",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789025320",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162221102",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789042114",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222506",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789045614",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789045914",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425027901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934016291",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420052920",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425018002",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804017714",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008320",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425018003",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425027903",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804006020",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093227034",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet Chewable 200-28.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093227234",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet Chewable 400-57 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00548909010",
      "ndc_label_name": "Amphadase SOLUTION 150 UNIT/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664095088",
      "ndc_label_name": "Amphet-Dextroamphet 3-Bead ER Capsule Extended Release 24 Hour 12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480368301",
      "ndc_label_name": "Amphet-Dextroamphet 3-Bead ER Capsule Extended Release 24 Hour 12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480368401",
      "ndc_label_name": "Amphet-Dextroamphet 3-Bead ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406080301",
      "ndc_label_name": "Amphet-Dextroamphet 3-Bead ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664095188",
      "ndc_label_name": "Amphet-Dextroamphet 3-Bead ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480368501",
      "ndc_label_name": "Amphet-Dextroamphet 3-Bead ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664095288",
      "ndc_label_name": "Amphet-Dextroamphet 3-Bead ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406080701",
      "ndc_label_name": "Amphet-Dextroamphet 3-Bead ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406080401",
      "ndc_label_name": "Amphet-Dextroamphet 3-Bead ER Capsule Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480368601",
      "ndc_label_name": "Amphet-Dextroamphet 3-Bead ER Capsule Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664095388",
      "ndc_label_name": "Amphet-Dextroamphet 3-Bead ER Capsule Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480331819",
      "ndc_label_name": "Amphetamine ER Tablet Extended Release Dispersible 12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62542002030",
      "ndc_label_name": "Amphetamine ER Tablet Extended Release Dispersible 12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480331865",
      "ndc_label_name": "Amphetamine ER Tablet Extended Release Dispersible 12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480331919",
      "ndc_label_name": "Amphetamine ER Tablet Extended Release Dispersible 15.7 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480331965",
      "ndc_label_name": "Amphetamine ER Tablet Extended Release Dispersible 15.7 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62542002530",
      "ndc_label_name": "Amphetamine ER Tablet Extended Release Dispersible 15.7 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480332065",
      "ndc_label_name": "Amphetamine ER Tablet Extended Release Dispersible 18.8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480332019",
      "ndc_label_name": "Amphetamine ER Tablet Extended Release Dispersible 18.8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62542003030",
      "ndc_label_name": "Amphetamine ER Tablet Extended Release Dispersible 18.8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480331565",
      "ndc_label_name": "Amphetamine ER Tablet Extended Release Dispersible 3.1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62542000530",
      "ndc_label_name": "Amphetamine ER Tablet Extended Release Dispersible 3.1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480331519",
      "ndc_label_name": "Amphetamine ER Tablet Extended Release Dispersible 3.1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480331619",
      "ndc_label_name": "Amphetamine ER Tablet Extended Release Dispersible 6.3 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480331665",
      "ndc_label_name": "Amphetamine ER Tablet Extended Release Dispersible 6.3 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62542001030",
      "ndc_label_name": "Amphetamine ER Tablet Extended Release Dispersible 6.3 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62542001530",
      "ndc_label_name": "Amphetamine ER Tablet Extended Release Dispersible 9.4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480331765",
      "ndc_label_name": "Amphetamine ER Tablet Extended Release Dispersible 9.4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480331719",
      "ndc_label_name": "Amphetamine ER Tablet Extended Release Dispersible 9.4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598089801",
      "ndc_label_name": "Amphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406122001",
      "ndc_label_name": "Amphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629207801",
      "ndc_label_name": "Amphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238156401",
      "ndc_label_name": "Amphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52536005910",
      "ndc_label_name": "Amphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547045810",
      "ndc_label_name": "Amphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162108801",
      "ndc_label_name": "Amphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52536005903",
      "ndc_label_name": "Amphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664007588",
      "ndc_label_name": "Amphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527252537",
      "ndc_label_name": "Amphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629111401",
      "ndc_label_name": "Amphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162161303",
      "ndc_label_name": "Amphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70010004101",
      "ndc_label_name": "Amphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452022820",
      "ndc_label_name": "Amphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162136901",
      "ndc_label_name": "Amphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527252437",
      "ndc_label_name": "Amphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598089701",
      "ndc_label_name": "Amphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238156301",
      "ndc_label_name": "Amphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547045710",
      "ndc_label_name": "Amphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52536005703",
      "ndc_label_name": "Amphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406121901",
      "ndc_label_name": "Amphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70010004001",
      "ndc_label_name": "Amphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52536005710",
      "ndc_label_name": "Amphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452022720",
      "ndc_label_name": "Amphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629111501",
      "ndc_label_name": "Amphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162108701",
      "ndc_label_name": "Amphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664006288",
      "ndc_label_name": "Amphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162161203",
      "ndc_label_name": "Amphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629207901",
      "ndc_label_name": "Amphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162136801",
      "ndc_label_name": "Amphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527551137",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228305911",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527079137",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407054901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115148701",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406895201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018601",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781233501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975033210",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205601",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573046502",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664033788",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858061001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049825",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010003001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884084001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205606",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975027810",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629197301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629210301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162137801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850051101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205603",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049895",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205609",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993059502",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115148801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527551237",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781234301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573046602",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228306311",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975027910",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629210601",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664033888",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406895301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018701",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884084101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629197401",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850051201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993059602",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858021501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527079237",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205701",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010003101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975033310",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205709",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205703",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205706",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228306011",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687050925",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527551337",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115148901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406895401",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687050995",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527079337",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781235201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407056001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975028010",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884084201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205806",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573046702",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975033410",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629197501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629210701",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664033988",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850051301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993059702",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205803",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010003201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205809",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162137901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527551437",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573046802",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884084301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115149001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858032501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527079437",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406895501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664034088",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205903",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228306411",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407056101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850051401",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629197601",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975028110",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205906",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993059802",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205909",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781236801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975033510",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162138001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629210801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010003301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781237101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527551537",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629197701",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722019501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858093001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115149101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629210901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228306111",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687052025",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407056201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162138101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573046902",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884084401",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975033610",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162206006",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406895601",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687052095",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850051501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010003401",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527079537",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993059902",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975028210",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664034188",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162206003",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162206001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162206009",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975033110",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115148601",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527551037",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010002901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406895101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850051001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629197801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228306211",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055701",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527079037",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573046402",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858005501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781232901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975027710",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993059402",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162137701",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664033688",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205503",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884083901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407054801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629211001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205506",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205509",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555097202",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806034101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406889201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150237",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185084201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687064495",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064308",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076237",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687064425",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781017601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462064901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629238001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205009",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107007001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010011301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015701",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205003",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516001401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205006",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205103",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150337",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064408",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076337",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555077602",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205106",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205109",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629237701",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010011401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162123601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107007201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781017801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064508",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076437",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406888501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629237801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150437",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462065101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806034301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555077702",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205203",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205206",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010011501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205209",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516001301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555097302",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406889301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806034401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185085301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076537",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629238201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722016301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064608",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150537",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107007301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162225101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080701",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205303",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629373101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462065201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205309",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781017901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516001201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010011601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205306",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185209901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781018001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107007401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076637",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205403",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185086401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722016401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150637",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406889401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064708",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629238101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555097402",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806034501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010011701",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462065301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205406",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516001101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072701",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205409",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462064701",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185209801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555097102",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406889101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150037",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162204809",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714094801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064108",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629237901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076037",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806033901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107006801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162204806",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010011101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162204801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781017401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629373201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516001601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162204803",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629237601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406888401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150137",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555077502",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 7.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076137",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714094901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162204903",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162204901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162204906",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010011201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064208",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 7.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162123501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162204909",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67457092650",
      "ndc_label_name": "Amphotericin B Liposome Suspension Reconstituted 50 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155059431",
      "ndc_label_name": "Amphotericin B Liposome Suspension Reconstituted 50 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150036501",
      "ndc_label_name": "Amphotericin B Liposome Suspension Reconstituted 50 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756023301",
      "ndc_label_name": "Amphotericin B Liposome Suspension Reconstituted 50 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756095401",
      "ndc_label_name": "Amphotericin B Liposome Suspension Reconstituted 50 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019108",
      "ndc_label_name": "Amphotericin B POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019104",
      "ndc_label_name": "Amphotericin B POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019100",
      "ndc_label_name": "Amphotericin B POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991117305",
      "ndc_label_name": "Amphotericin B POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019103",
      "ndc_label_name": "Amphotericin B POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019106",
      "ndc_label_name": "Amphotericin B POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019105",
      "ndc_label_name": "Amphotericin B POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991117306",
      "ndc_label_name": "Amphotericin B POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927172600",
      "ndc_label_name": "Amphotericin B POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991117304",
      "ndc_label_name": "Amphotericin B POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991117302",
      "ndc_label_name": "Amphotericin B POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552030401",
      "ndc_label_name": "Amphotericin B POWDER 905 UNIT/MG",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552030404",
      "ndc_label_name": "Amphotericin B POWDER 905 UNIT/MG",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552030402",
      "ndc_label_name": "Amphotericin B POWDER 905 UNIT/MG",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552030409",
      "ndc_label_name": "Amphotericin B POWDER 905 UNIT/MG",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552030405",
      "ndc_label_name": "Amphotericin B POWDER 905 UNIT/MG",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552030403",
      "ndc_label_name": "Amphotericin B POWDER 905 UNIT/MG",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822105505",
      "ndc_label_name": "Amphotericin B Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781214501",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959038928",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781214505",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959038940",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440711640",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651055101",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651055105",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002528",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959038930",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005928",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002530",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959038920",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629426601",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002540",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518260700",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155091641",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340485",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457035110",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940495",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409372601",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340495",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940485",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781926185",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409372610",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485042110",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860011441",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021013610",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011310",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781926195",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155091631",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219001810",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219001801",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603036301",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603036310",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008602",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572001610",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567010210",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022241",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022202",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457035101",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67850002110",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67850002100",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572001601",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008601",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860011415",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485042101",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781341292",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781341215",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011599",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485042301",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860011899",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340995",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409372501",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940946",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409372511",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340946",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008801",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940995",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603057801",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567010401",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634010099",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022415",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021019799",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457040410",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485042310",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340095",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 125 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940178",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 125 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940195",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 125 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340078",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 125 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781927380",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409372001",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409372010",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340880",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340895",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219002003",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940880",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022341",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860011541",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155091731",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021013720",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781927395",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940895",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022302",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567010310",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008702",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485042210",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860011526",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011420",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090455200",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155091741",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457035210",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457035202",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572001710",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603045401",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485042201",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219002023",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572001701",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67850002200",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008701",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67850002210",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603045410",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572009401",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572009410",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781341392",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781341315",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219001401",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340295",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781924295",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340278",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022002",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457035325",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781924278",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008401",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008402",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011110",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860011215",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940278",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860011241",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022041",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940295",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567010010",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219001410",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457035310",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409371810",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340778",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940778",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155091541",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781925095",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781925078",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409371801",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603022110",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021013510",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781940795",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155091531",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219001610",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219001601",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67850002410",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781340795",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022141",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567010110",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011210",
      "ndc_label_name": "Ampicillin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457035050",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008502",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457035010",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794022102",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603022101",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67850002400",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860011341",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008501",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860011315",
      "ndc_label_name": "Ampicillin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641611601",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 1.5 (1-0.5) GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011601",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021014220",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 1.5 (1-0.5) GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794020641",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794024102",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572002101",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288003121",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641611610",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 1.5 (1-0.5) GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567021010",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 1.5 (1-0.5) GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794020602",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288000521",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288003191",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485041610",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457034810",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603022001",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011620",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 1.5 (1-0.5) GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011610",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008101",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572002110",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603022010",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794024141",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008102",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485041601",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288000520",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288003120",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634010920",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288003192",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634010941",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409268921",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409268901",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011899",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641611801",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 15 (10-5) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008301",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567021201",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 15 (10-5) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457064910",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485041801",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288000775",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288003391",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794020815",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021014499",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 15 (10-5) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603044401",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011801",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485041815",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634010899",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794024315",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288003375",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641611710",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 3 (2-1) GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794024241",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011720",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 3 (2-1) GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567021110",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 3 (2-1) GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641612301",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641612310",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008202",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641611701",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 3 (2-1) GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794020741",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603033501",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288003221",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457034910",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567015010",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011710",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288003291",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021014330",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium SOLUTION RECONSTITUTED 3 (2-1) GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150011701",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634011041",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288003292",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288003220",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008201",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794020702",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603033510",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794024202",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485041701",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288000630",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634011020",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485041710",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572002201",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288000631",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572002210",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409298703",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572013601",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409298723",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572013610",
      "ndc_label_name": "Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10144042760",
      "ndc_label_name": "Ampyra Tablet Extended Release 12 Hour 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459070060",
      "ndc_label_name": "Amrix Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63459070160",
      "ndc_label_name": "Amrix Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71336100301",
      "ndc_label_name": "Amvuttra Solution Prefilled Syringe 25 MG/0.5ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00187430305",
      "ndc_label_name": "Amytal Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42192080401",
      "ndc_label_name": "Ana-Lex Kit 2-2 % Rectal",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10481100201",
      "ndc_label_name": "Anacaine Ointment 10 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406990603",
      "ndc_label_name": "Anafranil CAPSULE 25 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406990703",
      "ndc_label_name": "Anafranil CAPSULE 50 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406990803",
      "ndc_label_name": "Anafranil CAPSULE 75 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668045301",
      "ndc_label_name": "Anagrelide HCl CAPSULE 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00172524160",
      "ndc_label_name": "Anagrelide HCl Capsule 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135031212",
      "ndc_label_name": "Anagrelide HCl Capsule 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954087910",
      "ndc_label_name": "Anagrelide HCl Capsule 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135031360",
      "ndc_label_name": "Anagrelide HCl Capsule 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668046201",
      "ndc_label_name": "Anagrelide HCl CAPSULE 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954088110",
      "ndc_label_name": "Anagrelide HCl Capsule 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00172524060",
      "ndc_label_name": "Anagrelide HCl Capsule 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54766079964",
      "ndc_label_name": "Analpram HC Singles Cream 2.5-1 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959050001",
      "ndc_label_name": "Analpram-HC Cream 1-1 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54766077804",
      "ndc_label_name": "Analpram-HC Cream 1-1 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54766082904",
      "ndc_label_name": "Analpram-HC Lotion 2.5-1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00225029515",
      "ndc_label_name": "Anaspaz Tablet Dispersible 0.125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00225029520",
      "ndc_label_name": "Anaspaz Tablet Dispersible 0.125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991317603",
      "ndc_label_name": "Anastrozole Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779255503",
      "ndc_label_name": "Anastrozole POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779255504",
      "ndc_label_name": "Anastrozole POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052024825",
      "ndc_label_name": "Anastrozole Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457982901",
      "ndc_label_name": "Anastrozole Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927443500",
      "ndc_label_name": "Anastrozole POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991317601",
      "ndc_label_name": "Anastrozole Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779255506",
      "ndc_label_name": "Anastrozole POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052024800",
      "ndc_label_name": "Anastrozole Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144020001",
      "ndc_label_name": "Anastrozole POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457982902",
      "ndc_label_name": "Anastrozole Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991317602",
      "ndc_label_name": "Anastrozole Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052024805",
      "ndc_label_name": "Anastrozole Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552156801",
      "ndc_label_name": "Anastrozole Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393020104",
      "ndc_label_name": "Anastrozole Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393020107",
      "ndc_label_name": "Anastrozole Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393020105",
      "ndc_label_name": "Anastrozole Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393020108",
      "ndc_label_name": "Anastrozole Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155085709",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571042103",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729003515",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008590",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904619546",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155085703",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991062033",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093753656",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291001690",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155085705",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090245300",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063038315",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729003510",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090500201",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135049030",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090500200",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651023630",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063038306",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090581200",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268007515",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729003516",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015504",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382020910",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687011211",
      "ndc_label_name": "Anastrozole TABLET 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135049090",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090245301",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268007511",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429028630",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291001630",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090581201",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518242000",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687011221",
      "ndc_label_name": "Anastrozole TABLET 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518248400",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991062090",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629526905",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629526901",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008530",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651023690",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189041530",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117000301",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991062010",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187008018",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789000890",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382020906",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187008020",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187008090",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015508",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789034215",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518242001",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518248401",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804016290",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789000815",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804016230",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63833092520",
      "ndc_label_name": "Andembry Solution Auto-Injector 200 MG/1.2ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63833092501",
      "ndc_label_name": "Andembry Solution Auto-Injector 200 MG/1.2ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00023599002",
      "ndc_label_name": "Androderm Patch 24 Hour 2 MG/24HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023599060",
      "ndc_label_name": "Androderm Patch 24 Hour 2 MG/24HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023599230",
      "ndc_label_name": "Androderm Patch 24 Hour 4 MG/24HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00023599204",
      "ndc_label_name": "Androderm Patch 24 Hour 4 MG/24HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927159500",
      "ndc_label_name": "Androstenedione POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080225265",
      "ndc_label_name": "Angel Wing Blood Collect Set",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080225273",
      "ndc_label_name": "Angel Wing Blood Collect Set",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080225240",
      "ndc_label_name": "Angel Wing Luer Adapter/Holder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080225241",
      "ndc_label_name": "Angel Wing Transfer Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080225232",
      "ndc_label_name": "Angel Wing Tube Holder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419048201",
      "ndc_label_name": "Angeliq TABLET 0.25-0.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419048203",
      "ndc_label_name": "Angeliq TABLET 0.25-0.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419048303",
      "ndc_label_name": "Angeliq TABLET 0.5-1 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419048301",
      "ndc_label_name": "Angeliq TABLET 0.5-1 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991307502",
      "ndc_label_name": "Anhydrous Cream Base CREAM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991307501",
      "ndc_label_name": "Anhydrous Cream Base CREAM",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552115206",
      "ndc_label_name": "Anhydrous Gel Base GEL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927146500",
      "ndc_label_name": "Anise Extract Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927158000",
      "ndc_label_name": "Anise Flavor OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452064501",
      "ndc_label_name": "Anise OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00395191391",
      "ndc_label_name": "Anise Oil",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452064502",
      "ndc_label_name": "Anise OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452064503",
      "ndc_label_name": "Anise OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927368600",
      "ndc_label_name": "Anisindione POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71518000101",
      "ndc_label_name": "Anjeso Injectable 30 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50261031301",
      "ndc_label_name": "Annovera Ring 0.013-0.15 MG/24HR Vaginal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308075201",
      "ndc_label_name": "Annovera Ring 0.013-0.15 MG/24HR Vaginal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173086906",
      "ndc_label_name": "Anoro Ellipta Aerosol Powder Breath Activated 62.5-25 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173086910",
      "ndc_label_name": "Anoro Ellipta Aerosol Powder Breath Activated 62.5-25 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173086961",
      "ndc_label_name": "Anoro Ellipta Aerosol Powder Breath Activated 62.5-25 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27437010706",
      "ndc_label_name": "Antara Capsule 30 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452066002",
      "ndc_label_name": "Anthralin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452066003",
      "ndc_label_name": "Anthralin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452066004",
      "ndc_label_name": "Anthralin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552137902",
      "ndc_label_name": "Anthralin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552137904",
      "ndc_label_name": "Anthralin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452066001",
      "ndc_label_name": "Anthralin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452066005",
      "ndc_label_name": "Anthralin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927386900",
      "ndc_label_name": "Anthralin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999074410",
      "ndc_label_name": "Antibiotic Ear Solution 3.5-10000-1 Otic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452067001",
      "ndc_label_name": "Antimony Potassium Tartrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452067002",
      "ndc_label_name": "Antimony Potassium Tartrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452067004",
      "ndc_label_name": "Antimony Potassium Tartrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927142600",
      "ndc_label_name": "Antimony Trichloride CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927451300",
      "ndc_label_name": "Antimony Trisulfide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927129200",
      "ndc_label_name": "Antipyrine CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452068103",
      "ndc_label_name": "Antipyrine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452068101",
      "ndc_label_name": "Antipyrine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452068102",
      "ndc_label_name": "Antipyrine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452068104",
      "ndc_label_name": "Antipyrine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006542402",
      "ndc_label_name": "Antivenin Latrodectus Mactans KIT INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70199000401",
      "ndc_label_name": "Antivert Tablet 50 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70199001801",
      "ndc_label_name": "Antivert Tablet Chewable 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "30698022010",
      "ndc_label_name": "Anzemet Tablet 50 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50222028030",
      "ndc_label_name": "Anzupgo Cream 20 MG/GM External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702034001",
      "ndc_label_name": "Apadaz Tablet 4.08-325 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702034101",
      "ndc_label_name": "Apadaz Tablet 6.12-325 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702034201",
      "ndc_label_name": "Apadaz Tablet 8.16-325 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42195084010",
      "ndc_label_name": "APAP-Caff-Dihydrocodeine Capsule 320.5-30-16 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559036560",
      "ndc_label_name": "ApexiCon E Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559036530",
      "ndc_label_name": "ApexiCon E Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10337039560",
      "ndc_label_name": "ApexiCon E Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10337039530",
      "ndc_label_name": "ApexiCon E Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00088250200",
      "ndc_label_name": "Apidra SoloStar Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00088250205",
      "ndc_label_name": "Apidra SoloStar Solution Pen-injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00088250034",
      "ndc_label_name": "Apidra Solution 100 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00088250033",
      "ndc_label_name": "Apidra SOLUTION 100 UNIT/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57825000501",
      "ndc_label_name": "ApneaStrip",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505476505",
      "ndc_label_name": "APO-Varenicline Tablet 0.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090560500",
      "ndc_label_name": "APO-Varenicline Tablet 0.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090560400",
      "ndc_label_name": "APO-Varenicline Tablet 1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505476606",
      "ndc_label_name": "APO-Varenicline Tablet 1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27505000405",
      "ndc_label_name": "Apokyn Solution Cartridge 30 MG/3ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27505000401",
      "ndc_label_name": "Apokyn Solution Cartridge 30 MG/3ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452070001",
      "ndc_label_name": "Apomorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927230300",
      "ndc_label_name": "Apomorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779176404",
      "ndc_label_name": "Apomorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452070002",
      "ndc_label_name": "Apomorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779176400",
      "ndc_label_name": "Apomorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552065201",
      "ndc_label_name": "Apomorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452070003",
      "ndc_label_name": "Apomorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991151303",
      "ndc_label_name": "Apomorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552065209",
      "ndc_label_name": "Apomorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991151304",
      "ndc_label_name": "Apomorphine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452070004",
      "ndc_label_name": "Apomorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991151301",
      "ndc_label_name": "Apomorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779176403",
      "ndc_label_name": "Apomorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779176406",
      "ndc_label_name": "Apomorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552065202",
      "ndc_label_name": "Apomorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991151302",
      "ndc_label_name": "Apomorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817072005",
      "ndc_label_name": "Apomorphine HCl Solution Cartridge 30 MG/3ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817072001",
      "ndc_label_name": "Apomorphine HCl Solution Cartridge 30 MG/3ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70568601801",
      "ndc_label_name": "App Slim Rms CAPSULE ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840570005",
      "ndc_label_name": "Apple (Diagnostic) Solution 1:40 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86067000000",
      "ndc_label_name": "Apple Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779199908",
      "ndc_label_name": "Apple Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991166703",
      "ndc_label_name": "Apple Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779199901",
      "ndc_label_name": "Apple Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779199905",
      "ndc_label_name": "Apple Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779297601",
      "ndc_label_name": "Apple Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779199902",
      "ndc_label_name": "Apple Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779297602",
      "ndc_label_name": "Apple Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927217100",
      "ndc_label_name": "Apple Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452339002",
      "ndc_label_name": "Apple Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991305901",
      "ndc_label_name": "Apple Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991166701",
      "ndc_label_name": "Apple Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452339001",
      "ndc_label_name": "Apple Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991166704",
      "ndc_label_name": "Apple Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927300900",
      "ndc_label_name": "Apple Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452069103",
      "ndc_label_name": "Apple Flavor Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452069104",
      "ndc_label_name": "Apple Flavor Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779200003",
      "ndc_label_name": "Apple Flavor POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779200008",
      "ndc_label_name": "Apple Flavor POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452069101",
      "ndc_label_name": "Apple Flavor Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552088505",
      "ndc_label_name": "Apple Flavor POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927289600",
      "ndc_label_name": "Apple Flavor POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779200001",
      "ndc_label_name": "Apple Flavor POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927341100",
      "ndc_label_name": "Apple Flavor POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991151202",
      "ndc_label_name": "Apple Flavor Water Miscible POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991151203",
      "ndc_label_name": "Apple Flavor Water Miscible POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991151204",
      "ndc_label_name": "Apple Flavor Water Miscible POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17478071610",
      "ndc_label_name": "Apraclonidine HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314066505",
      "ndc_label_name": "Apraclonidine HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071611",
      "ndc_label_name": "Apraclonidine HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314066510",
      "ndc_label_name": "Apraclonidine HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781406336",
      "ndc_label_name": "Aprepitant 80 & 125 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781232306",
      "ndc_label_name": "Aprepitant Capsule 125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407070366",
      "ndc_label_name": "Aprepitant Capsule 125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001066819",
      "ndc_label_name": "Aprepitant Capsule 125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462058576",
      "ndc_label_name": "Aprepitant CAPSULE 125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407070306",
      "ndc_label_name": "Aprepitant Capsule 125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781232368",
      "ndc_label_name": "Aprepitant CAPSULE 125 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668059386",
      "ndc_label_name": "Aprepitant Capsule 125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462058540",
      "ndc_label_name": "Aprepitant CAPSULE 125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668059181",
      "ndc_label_name": "Aprepitant Capsule 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781232106",
      "ndc_label_name": "Aprepitant CAPSULE 40 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668059182",
      "ndc_label_name": "Aprepitant Capsule 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781232151",
      "ndc_label_name": "Aprepitant CAPSULE 40 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407070101",
      "ndc_label_name": "Aprepitant Capsule 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407070105",
      "ndc_label_name": "Aprepitant Capsule 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001066601",
      "ndc_label_name": "Aprepitant Capsule 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462058385",
      "ndc_label_name": "Aprepitant CAPSULE 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462058340",
      "ndc_label_name": "Aprepitant CAPSULE 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001066617",
      "ndc_label_name": "Aprepitant Capsule 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668059487",
      "ndc_label_name": "Aprepitant Capsule 80 & 125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781406336",
      "ndc_label_name": "Aprepitant CAPSULE 80 & 125 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407070403",
      "ndc_label_name": "Aprepitant Capsule 80 & 125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001066915",
      "ndc_label_name": "Aprepitant Capsule 80 & 125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462011233",
      "ndc_label_name": "Aprepitant CAPSULE 80 & 125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462058476",
      "ndc_label_name": "Aprepitant CAPSULE 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407070202",
      "ndc_label_name": "Aprepitant Capsule 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668059284",
      "ndc_label_name": "Aprepitant Capsule 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781232246",
      "ndc_label_name": "Aprepitant CAPSULE 80 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668059283",
      "ndc_label_name": "Aprepitant Capsule 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407070222",
      "ndc_label_name": "Aprepitant Capsule 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668059285",
      "ndc_label_name": "Aprepitant Capsule 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781232268",
      "ndc_label_name": "Aprepitant CAPSULE 80 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668059286",
      "ndc_label_name": "Aprepitant Capsule 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001066719",
      "ndc_label_name": "Aprepitant Capsule 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407070206",
      "ndc_label_name": "Aprepitant Capsule 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001066701",
      "ndc_label_name": "Aprepitant Capsule 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407070211",
      "ndc_label_name": "Aprepitant Capsule 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462058440",
      "ndc_label_name": "Aprepitant CAPSULE 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462058458",
      "ndc_label_name": "Aprepitant CAPSULE 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49702028063",
      "ndc_label_name": "Apretude Suspension Extended Release 600 MG/3ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49702023803",
      "ndc_label_name": "Apretude Suspension Extended Release 600 MG/3ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49702026423",
      "ndc_label_name": "Apretude Suspension Extended Release 600 MG/3ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555904358",
      "ndc_label_name": "Apri TABLET 0.15-30 MG-MCG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555904379",
      "ndc_label_name": "Apri TABLET 0.15-30 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090248100",
      "ndc_label_name": "Apri Tablet 0.15-30 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927217000",
      "ndc_label_name": "Apricot Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927329700",
      "ndc_label_name": "Apricot Flavor POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59088071100",
      "ndc_label_name": "Aprizio Pak Kit 2.5-2.5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42858040145",
      "ndc_label_name": "Aptensio XR Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858040245",
      "ndc_label_name": "Aptensio XR Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858040345",
      "ndc_label_name": "Aptensio XR Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858040445",
      "ndc_label_name": "Aptensio XR Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858040545",
      "ndc_label_name": "Aptensio XR Capsule Extended Release 24 Hour 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858040645",
      "ndc_label_name": "Aptensio XR Capsule Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858040745",
      "ndc_label_name": "Aptensio XR Capsule Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63402020230",
      "ndc_label_name": "Aptiom Tablet 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63402020430",
      "ndc_label_name": "Aptiom Tablet 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63402020660",
      "ndc_label_name": "Aptiom Tablet 600 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63402020830",
      "ndc_label_name": "Aptiom Tablet 800 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00597000302",
      "ndc_label_name": "Aptivus CAPSULE 250 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10118089036",
      "ndc_label_name": "AQ Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10118089032",
      "ndc_label_name": "AQ Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10118089040",
      "ndc_label_name": "AQ Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10118089028",
      "ndc_label_name": "AQInject Pen Needle 31G X 5 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10118089025",
      "ndc_label_name": "AQInject Pen Needle 32G X 4 MM",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83853010101",
      "ndc_label_name": "Aqneursa Packet 1 GM Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71334023500",
      "ndc_label_name": "Aqvesme Tablet 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71334023514",
      "ndc_label_name": "Aqvesme Tablet 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944281501",
      "ndc_label_name": "Aralast NP SOLUTION RECONSTITUTED 1000 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944281401",
      "ndc_label_name": "Aralast NP SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555906667",
      "ndc_label_name": "Aranelle Tablet 0.5/1/0.5-35 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555906679",
      "ndc_label_name": "Aranelle Tablet 0.5/1/0.5-35 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000501",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 100 MCG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000504",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 100 MCG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000601",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 200 MCG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000201",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 25 MCG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000204",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 25 MCG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000304",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 40 MCG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000301",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 40 MCG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000401",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 60 MCG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000404",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 60 MCG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513009801",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 10 MCG/0.4ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513009804",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 10 MCG/0.4ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002501",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 100 MCG/0.5ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002504",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 100 MCG/0.5ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002701",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 150 MCG/0.3ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002704",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 150 MCG/0.3ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002801",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 200 MCG/0.4ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513005704",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 25 MCG/0.42ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513005701",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 25 MCG/0.42ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513011101",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 300 MCG/0.6ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002104",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 40 MCG/0.4ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002101",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 40 MCG/0.4ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513003201",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 500 MCG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002301",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 60 MCG/0.3ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002304",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 60 MCG/0.3ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00088216030",
      "ndc_label_name": "Arava TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00088216130",
      "ndc_label_name": "Arava TABLET 20 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83245005306",
      "ndc_label_name": "Arbli Suspension 10 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927418700",
      "ndc_label_name": "Arbutin Alpha POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73604091401",
      "ndc_label_name": "Arcalyst Solution Reconstituted 220 MG Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73604091404",
      "ndc_label_name": "Arcalyst Solution Reconstituted 220 MG Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160084811",
      "ndc_label_name": "Arexvy Suspension Reconstituted 120 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571046473",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332063304",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598077760",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093595506",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093595556",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571046475",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756027702",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093595511",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332063301",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266025904",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097016832",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742039560",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598077730",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742039530",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756061260",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093595545",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332063360",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603020830",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097016853",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687077083",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756061270",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687077079",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266025930",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332063330",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462083335",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687077084",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748025730",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756027703",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266025960",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462083365",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097016887",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097016864",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603020801",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756061212",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436015119",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436015120",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436015157",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603020860",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436015158",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748017530",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603020804",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204002602",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043005293",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748017560",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204002601",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748025760",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756061244",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266025901",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043005260",
      "ndc_label_name": "Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452071502",
      "ndc_label_name": "Arginine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991158605",
      "ndc_label_name": "Arginine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779050303",
      "ndc_label_name": "Arginine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991158602",
      "ndc_label_name": "Arginine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779050305",
      "ndc_label_name": "Arginine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779050309",
      "ndc_label_name": "Arginine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779050308",
      "ndc_label_name": "Arginine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779050304",
      "ndc_label_name": "Arginine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452071503",
      "ndc_label_name": "Arginine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452071501",
      "ndc_label_name": "Arginine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927205600",
      "ndc_label_name": "Arginine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991158601",
      "ndc_label_name": "Arginine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452071504",
      "ndc_label_name": "Arginine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552102404",
      "ndc_label_name": "Arginine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552102405",
      "ndc_label_name": "Arginine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991158603",
      "ndc_label_name": "Arginine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991158604",
      "ndc_label_name": "Arginine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72627241401",
      "ndc_label_name": "Arginine HCl Solution 6 GM/30ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080531020",
      "ndc_label_name": "Argyle Saratoga Sump Drain",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080531038",
      "ndc_label_name": "Argyle Saratoga Sump Drain",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080531046",
      "ndc_label_name": "Argyle Saratoga Sump Drain",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080102000",
      "ndc_label_name": "Argyle Sterile Saline Solution 0.9 % Irrigation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080100000",
      "ndc_label_name": "Argyle Sterile Water Solution Irrigation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105073703",
      "ndc_label_name": "Aricept TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105073709",
      "ndc_label_name": "Aricept TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289015121",
      "ndc_label_name": "Aricept Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289015130",
      "ndc_label_name": "Aricept Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62856024630",
      "ndc_label_name": "Aricept TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62856024730",
      "ndc_label_name": "Aricept TABLET 23 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105073903",
      "ndc_label_name": "Aricept TABLET 5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62856024530",
      "ndc_label_name": "Aricept TABLET 5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105073909",
      "ndc_label_name": "Aricept TABLET 5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71558059028",
      "ndc_label_name": "Arikayce Suspension 590 MG/8.4ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559067030",
      "ndc_label_name": "Arimidex Tablet 1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689073505",
      "ndc_label_name": "ARIPiprazole Solution 1 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54838057059",
      "ndc_label_name": "ARIPiprazole SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722068415",
      "ndc_label_name": "ARIPiprazole Solution 1 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135090451",
      "ndc_label_name": "ARIPiprazole Solution 1 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70752011407",
      "ndc_label_name": "ARIPiprazole Solution 1 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603044501",
      "ndc_label_name": "ARIPiprazole Solution 1 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162089374",
      "ndc_label_name": "ARIPiprazole SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651011055",
      "ndc_label_name": "ARIPiprazole Solution 1 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010020",
      "ndc_label_name": "ARIPiprazole Solution 1 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505040405",
      "ndc_label_name": "ARIPiprazole SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668021890",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904736806",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904736861",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714014301",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904651106",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714078501",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668021805",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729028001",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353014715",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729028010",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668021830",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722082730",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904651161",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353014705",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353014745",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598055630",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547088650",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241005308",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090307300",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429044830",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241005303",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547030403",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598096730",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332009971",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090640901",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300017713",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332009931",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505267403",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547088603",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090493601",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268008915",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877043205",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739007410",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342012407",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162089803",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505267408",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268008911",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687017901",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687017965",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518282000",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877043201",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "48433011710",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788692102",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687017911",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877043203",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332009930",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788692106",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335190301",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518276500",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629700301",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780806",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162089809",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780803",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862066330",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788692109",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804023690",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865018230",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862066305",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780809",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788692103",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518282002",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780801",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518282001",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518142102",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335190303",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788692101",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335190302",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518142101",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162236905",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780802",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865015505",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518258000",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865018205",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518142103",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282004630",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335190304",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189047630",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865015530",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009009005",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804002330",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668021990",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668021930",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729028101",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904651204",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547030503",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342012507",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668021905",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714078601",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090282400",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714014401",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729028110",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904736904",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598096830",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598055730",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241005403",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547088703",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429044930",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518256700",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241005408",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687019194",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "48433011810",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687019111",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722082830",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009011",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505267508",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518286900",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300017813",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162089903",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090269100",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332010071",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629710801",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862066405",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687019121",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788700606",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547088750",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162089909",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332010030",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865015630",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788700601",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877043305",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877043303",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282004730",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009012",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862066430",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518256701",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877043301",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518250801",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518286902",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788700602",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505267503",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518264300",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518286901",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788700603",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332010031",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865018330",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865018305",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788700609",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739007833",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009009105",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518250800",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865015605",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342012207",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714078301",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090748501",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729027810",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904736604",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904650904",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547030203",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722081930",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332009730",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729027801",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268008711",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241005108",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668021605",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668021630",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547088403",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547088450",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788707606",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "48433011510",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332009731",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090748500",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668021690",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714014101",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598096530",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090710500",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788773301",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090756400",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629701701",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687015721",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241005103",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300017513",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090756401",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268008712",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518338001",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505307508",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788707603",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162089609",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687015711",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598055430",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518273600",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687015794",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332009771",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162089603",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788707609",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862066105",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739006933",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429044630",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518338000",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862066130",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518309000",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877043003",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788773302",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877043001",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865015330",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505307503",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335168201",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877043005",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518258401",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788707602",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205048030",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788773303",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189046630",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788707601",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518295800",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788773306",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788773309",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518258400",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335198001",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865018005",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865015305",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335189201",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009008805",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865018030",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668022005",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729028201",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904737004",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714014501",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877043403",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518251401",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547088850",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904651304",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300017913",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241005508",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668022030",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241005503",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788706309",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518280602",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090640300",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668022090",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722082930",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342012607",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547088803",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353014009",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518255700",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865015705",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687020211",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714078701",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353014005",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353014015",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332010130",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353014045",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518301101",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282004830",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877043401",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729028210",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598055830",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "48433011910",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332010171",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547030603",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335168701",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090712500",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788706303",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090486300",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009111",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687020294",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877043405",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598096930",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865018430",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162090103",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788706301",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090606300",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429045030",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162090109",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518251400",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009112",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505267603",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862066530",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518301100",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518280600",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505267608",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788706302",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788706306",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687020221",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518300400",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865015730",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518300401",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760069130",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189045530",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332010131",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862066505",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518251402",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518280601",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865018405",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714014601",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598055930",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "48433012010",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714078801",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668022105",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904737104",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547030703",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904651404",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162090209",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877043505",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009211",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300018013",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722083030",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332010271",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547088903",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668022130",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518256500",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518297401",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429045130",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547088950",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342012707",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668022190",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332010231",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009212",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518282700",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729028301",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687021394",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862066630",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598097030",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729028310",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862066605",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877043501",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518297400",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241005603",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518282701",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518256501",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505267703",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241005608",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877043503",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353014805",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505267708",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353014815",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865018505",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353014845",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332010230",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687021311",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518130300",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687021321",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865015830",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162090203",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865015805",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865018530",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547088503",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353018015",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668021730",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904651006",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714014201",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722082030",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668021705",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904651061",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788716202",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090466500",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729027901",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904665640",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241005208",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342012307",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090583901",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904736706",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518282500",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090584000",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090307000",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904736761",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687016865",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547088550",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505267303",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714078401",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518292100",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739041310",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739007010",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668021790",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332009830",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598096630",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788716206",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729027910",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335183203",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862066230",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788808901",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547030303",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332009871",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090416000",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788774903",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241005203",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335183204",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877043105",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518097000",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598055530",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162089709",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090583900",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788774906",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300017613",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189045630",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788808902",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518292102",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090466501",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862066205",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090656300",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518126300",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353018079",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877043103",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518253600",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205039230",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090656301",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335151301",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268008811",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518251501",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "48433011610",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865018130",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518292101",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335183206",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788716209",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518282502",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687016801",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335189304",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268008815",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789046214",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335183202",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865015405",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788774901",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804023590",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687016811",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429044730",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865015430",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788808903",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332009831",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505267308",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009008905",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788808906",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877043101",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162089703",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788716201",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788808909",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788716203",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518282501",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788774902",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865018105",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788774909",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518295000",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518126301",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335183205",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518251500",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518289700",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335183201",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282004530",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578010678",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043040003",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598073330",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332010330",
      "ndc_label_name": "ARIPiprazole TABLET DISPERSIBLE 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452033813",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578010606",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578010706",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 15 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578010778",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 15 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332010430",
      "ndc_label_name": "ARIPiprazole TABLET DISPERSIBLE 15 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42043040103",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 15 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452033913",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 15 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598073430",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 15 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65757050003",
      "ndc_label_name": "Aristada Initio Prefilled Syringe 675 MG/2.4ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65757040401",
      "ndc_label_name": "Aristada Prefilled Syringe 1064 MG/3.9ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040403",
      "ndc_label_name": "Aristada Prefilled Syringe 1064 MG/3.9ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040101",
      "ndc_label_name": "Aristada Prefilled Syringe 441 MG/1.6ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040103",
      "ndc_label_name": "Aristada Prefilled Syringe 441 MG/1.6ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040203",
      "ndc_label_name": "Aristada Prefilled Syringe 662 MG/2.4ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040201",
      "ndc_label_name": "Aristada Prefilled Syringe 662 MG/2.4ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040303",
      "ndc_label_name": "Aristada Prefilled Syringe 882 MG/3.2ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040301",
      "ndc_label_name": "Aristada Prefilled Syringe 882 MG/3.2ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67457059500",
      "ndc_label_name": "Arixtra SOLUTION 10 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457059508",
      "ndc_label_name": "Arixtra SOLUTION 10 MG/0.8ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457059200",
      "ndc_label_name": "Arixtra SOLUTION 2.5 MG/0.5ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457059210",
      "ndc_label_name": "Arixtra SOLUTION 2.5 MG/0.5ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457059300",
      "ndc_label_name": "Arixtra SOLUTION 5 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457059304",
      "ndc_label_name": "Arixtra SOLUTION 5 MG/0.4ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457059406",
      "ndc_label_name": "Arixtra SOLUTION 7.5 MG/0.6ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457059400",
      "ndc_label_name": "Arixtra SOLUTION 7.5 MG/0.6ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927180300",
      "ndc_label_name": "Arlacel 165 POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927420300",
      "ndc_label_name": "Arlasilk Phospholipid PLN Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00781803731",
      "ndc_label_name": "Armodafinil TABLET 150 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189004160",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093309256",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378343293",
      "ndc_label_name": "Armodafinil TABLET 150 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335068101",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788003",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339017803",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788009",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189004190",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788006",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862080630",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919077030",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189004130",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789012690",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093309356",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782606",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782609",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651004730",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189035330",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862099830",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781804531",
      "ndc_label_name": "Armodafinil TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339017903",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782603",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700051030",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781805331",
      "ndc_label_name": "Armodafinil TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339018003",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093309456",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759306",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378343393",
      "ndc_label_name": "Armodafinil TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335130801",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862080730",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335184201",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189013330",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189026130",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759309",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759303",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789006090",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862080530",
      "ndc_label_name": "Armodafinil Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093309056",
      "ndc_label_name": "Armodafinil Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378343193",
      "ndc_label_name": "Armodafinil TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781802931",
      "ndc_label_name": "Armodafinil TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189046430",
      "ndc_label_name": "Armodafinil Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339017703",
      "ndc_label_name": "Armodafinil Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59310020006",
      "ndc_label_name": "ArmonAir Digihaler Aerosol Powder Breath Activated 113 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59310031106",
      "ndc_label_name": "ArmonAir Digihaler Aerosol Powder Breath Activated 232 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59310011406",
      "ndc_label_name": "ArmonAir Digihaler Aerosol Powder Breath Activated 55 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456046101",
      "ndc_label_name": "Armour Thyroid Tablet 120 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289026290",
      "ndc_label_name": "Armour Thyroid Tablet 120 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456104501",
      "ndc_label_name": "Armour Thyroid Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456045701",
      "ndc_label_name": "Armour Thyroid Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999028960",
      "ndc_label_name": "Armour Thyroid Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999028260",
      "ndc_label_name": "Armour Thyroid Tablet 180 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456046201",
      "ndc_label_name": "Armour Thyroid TABLET 180 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999028228",
      "ndc_label_name": "Armour Thyroid Tablet 180 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456046301",
      "ndc_label_name": "Armour Thyroid TABLET 240 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999028860",
      "ndc_label_name": "Armour Thyroid Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999028830",
      "ndc_label_name": "Armour Thyroid Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456045801",
      "ndc_label_name": "Armour Thyroid Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090018900",
      "ndc_label_name": "Armour Thyroid Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999028828",
      "ndc_label_name": "Armour Thyroid Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063034530",
      "ndc_label_name": "Armour Thyroid Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456046401",
      "ndc_label_name": "Armour Thyroid TABLET 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456045901",
      "ndc_label_name": "Armour Thyroid Tablet 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090019000",
      "ndc_label_name": "Armour Thyroid Tablet 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090019001",
      "ndc_label_name": "Armour Thyroid Tablet 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999070228",
      "ndc_label_name": "Armour Thyroid Tablet 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999070230",
      "ndc_label_name": "Armour Thyroid Tablet 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090019003",
      "ndc_label_name": "Armour Thyroid Tablet 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999028100",
      "ndc_label_name": "Armour Thyroid Tablet 90 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090169200",
      "ndc_label_name": "Armour Thyroid Tablet 90 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456046001",
      "ndc_label_name": "Armour Thyroid Tablet 90 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927222800",
      "ndc_label_name": "Arnica Flower TINCTURE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927494500",
      "ndc_label_name": "Arnica Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173087410",
      "ndc_label_name": "Arnuity Ellipta Aerosol Powder Breath Activated 100 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173087414",
      "ndc_label_name": "Arnuity Ellipta Aerosol Powder Breath Activated 100 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173087610",
      "ndc_label_name": "Arnuity Ellipta Aerosol Powder Breath Activated 200 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173087614",
      "ndc_label_name": "Arnuity Ellipta Aerosol Powder Breath Activated 200 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173088810",
      "ndc_label_name": "Arnuity Ellipta Aerosol Powder Breath Activated 50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999098630",
      "ndc_label_name": "Aromasin Tablet 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009766304",
      "ndc_label_name": "Aromasin TABLET 25 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927144100",
      "ndc_label_name": "Arsenic Trioxide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356046760",
      "ndc_label_name": "Arthrotec Tablet Delayed Release 50-0.2 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025141190",
      "ndc_label_name": "Arthrotec TABLET DELAYED RELEASE 50-0.2 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025141160",
      "ndc_label_name": "Arthrotec TABLET DELAYED RELEASE 50-0.2 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959053160",
      "ndc_label_name": "Arthrotec Tablet Delayed Release 50-0.2 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959053142",
      "ndc_label_name": "Arthrotec Tablet Delayed Release 50-0.2 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959053120",
      "ndc_label_name": "Arthrotec Tablet Delayed Release 50-0.2 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959053190",
      "ndc_label_name": "Arthrotec Tablet Delayed Release 50-0.2 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959053130",
      "ndc_label_name": "Arthrotec Tablet Delayed Release 50-0.2 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959052514",
      "ndc_label_name": "Arthrotec Tablet Delayed Release 75-0.2 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025142160",
      "ndc_label_name": "Arthrotec TABLET DELAYED RELEASE 75-0.2 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959052520",
      "ndc_label_name": "Arthrotec Tablet Delayed Release 75-0.2 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959052560",
      "ndc_label_name": "Arthrotec Tablet Delayed Release 75-0.2 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959052530",
      "ndc_label_name": "Arthrotec Tablet Delayed Release 75-0.2 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071131000",
      "ndc_label_name": "Arthrotec TABLET DELAYED RELEASE 75-0.2 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071069530",
      "ndc_label_name": "Arthrotec TABLET DELAYED RELEASE 75-0.2 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66312060116",
      "ndc_label_name": "Articadent Dental Solution Cartridge 4 %-1:100000 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69800025002",
      "ndc_label_name": "Asceniv Solution 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69800025001",
      "ndc_label_name": "Asceniv Solution 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991007405",
      "ndc_label_name": "Ascomp-Codeine CAPSULE 50-325-40-30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991007401",
      "ndc_label_name": "Ascomp-Codeine CAPSULE 50-325-40-30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62991260001",
      "ndc_label_name": "Ascorbic Acid Cassave POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991260002",
      "ndc_label_name": "Ascorbic Acid Cassave POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991260003",
      "ndc_label_name": "Ascorbic Acid Cassave POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991260004",
      "ndc_label_name": "Ascorbic Acid Cassave POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991260006",
      "ndc_label_name": "Ascorbic Acid Cassave POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991260005",
      "ndc_label_name": "Ascorbic Acid Cassave POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552016406",
      "ndc_label_name": "Ascorbic Acid GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552016407",
      "ndc_label_name": "Ascorbic Acid GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452074001",
      "ndc_label_name": "Ascorbic Acid Granules",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452074006",
      "ndc_label_name": "Ascorbic Acid Granules",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452074007",
      "ndc_label_name": "Ascorbic Acid Granules",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452074003",
      "ndc_label_name": "Ascorbic Acid Granules",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552016404",
      "ndc_label_name": "Ascorbic Acid GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452074002",
      "ndc_label_name": "Ascorbic Acid Granules",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779063409",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779063408",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779063407",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452074205",
      "ndc_label_name": "Ascorbic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779063405",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10695012670",
      "ndc_label_name": "Ascorbic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452074202",
      "ndc_label_name": "Ascorbic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452074201",
      "ndc_label_name": "Ascorbic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452074203",
      "ndc_label_name": "Ascorbic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452075004",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452074204",
      "ndc_label_name": "Ascorbic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452075005",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60592004811",
      "ndc_label_name": "Ascorbic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779063403",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552016302",
      "ndc_label_name": "Ascorbic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452075003",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452074206",
      "ndc_label_name": "Ascorbic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452075006",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60592004805",
      "ndc_label_name": "Ascorbic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552016306",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452075002",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60592004810",
      "ndc_label_name": "Ascorbic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552016305",
      "ndc_label_name": "Ascorbic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552016309",
      "ndc_label_name": "Ascorbic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452075007",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927509800",
      "ndc_label_name": "Ascorbic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457999601",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991101102",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552016304",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991101104",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927148300",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991101105",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552016307",
      "ndc_label_name": "Ascorbic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307004011",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457999603",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592004801",
      "ndc_label_name": "Ascorbic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991101101",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991101103",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307004015",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457999602",
      "ndc_label_name": "Ascorbic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72627240401",
      "ndc_label_name": "Ascorbic Acid Solution 15000 MG/30ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72627240501",
      "ndc_label_name": "Ascorbic Acid Solution 15000 MG/30ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72682224303",
      "ndc_label_name": "Ascorbic Acid Solution 500 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457011850",
      "ndc_label_name": "Ascorbic Acid Solution 500 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71384080010",
      "ndc_label_name": "Ascorbic Acid Solution 500 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72682224301",
      "ndc_label_name": "Ascorbic Acid Solution 500 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72682272603",
      "ndc_label_name": "Ascorbic Acid Solution 500 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72682272601",
      "ndc_label_name": "Ascorbic Acid Solution 500 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71414011501",
      "ndc_label_name": "Ascorbic Acid Solution 500 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552125308",
      "ndc_label_name": "Ascorbyl Palmitate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779090808",
      "ndc_label_name": "Ascorbyl Palmitate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452075402",
      "ndc_label_name": "Ascorbyl Palmitate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452075403",
      "ndc_label_name": "Ascorbyl Palmitate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779090805",
      "ndc_label_name": "Ascorbyl Palmitate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991156002",
      "ndc_label_name": "Ascorbyl Palmitate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779090804",
      "ndc_label_name": "Ascorbyl Palmitate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927359100",
      "ndc_label_name": "Ascorbyl Palmitate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991156003",
      "ndc_label_name": "Ascorbyl Palmitate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452075401",
      "ndc_label_name": "Ascorbyl Palmitate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452075404",
      "ndc_label_name": "Ascorbyl Palmitate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552125304",
      "ndc_label_name": "Ascorbyl Palmitate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552125309",
      "ndc_label_name": "Ascorbyl Palmitate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991156004",
      "ndc_label_name": "Ascorbyl Palmitate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991036017",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332019931",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794001710",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762288806",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991036060",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332019960",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762288801",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762109106",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 2.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991092817",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 2.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332054460",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 2.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991092860",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 2.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762109101",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 2.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332054410",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 2.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794001610",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991035860",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762201201",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762201206",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332019831",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332019860",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462064693",
      "ndc_label_name": "Ashlyna TABLET 0.15-0.03 &0.01 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462064691",
      "ndc_label_name": "Ashlyna TABLET 0.15-0.03 &0.01 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090209700",
      "ndc_label_name": "Ashlyna Tablet 0.15-0.03 &0.01 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70568602901",
      "ndc_label_name": "AsilNasalrms Capsule Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00085134101",
      "ndc_label_name": "Asmanex (120 Metered Doses) Aerosol Powder Breath Activated 220 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "78206011401",
      "ndc_label_name": "Asmanex (120 Metered Doses) Aerosol Powder Breath Activated 220 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00085134106",
      "ndc_label_name": "Asmanex (14 Metered Doses) Aerosol Powder Breath Activated 220 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356009914",
      "ndc_label_name": "Asmanex (14 Metered Doses) Aerosol Powder Breath Activated 220 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "78206011403",
      "ndc_label_name": "Asmanex (14 Metered Doses) Aerosol Powder Breath Activated 220 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00085146102",
      "ndc_label_name": "Asmanex (30 Metered Doses) Aerosol Powder Breath Activated 110 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "78206011501",
      "ndc_label_name": "Asmanex (30 Metered Doses) Aerosol Powder Breath Activated 110 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00085134107",
      "ndc_label_name": "Asmanex (30 Metered Doses) Aerosol Powder Breath Activated 220 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "78206011404",
      "ndc_label_name": "Asmanex (30 Metered Doses) Aerosol Powder Breath Activated 220 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00085134102",
      "ndc_label_name": "Asmanex (60 Metered Doses) Aerosol Powder Breath Activated 220 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "78206011402",
      "ndc_label_name": "Asmanex (60 Metered Doses) Aerosol Powder Breath Activated 220 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00085433301",
      "ndc_label_name": "Asmanex HFA Aerosol 100 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "78206011201",
      "ndc_label_name": "Asmanex HFA Aerosol 100 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "78206011301",
      "ndc_label_name": "Asmanex HFA Aerosol 200 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00085433401",
      "ndc_label_name": "Asmanex HFA Aerosol 200 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "78206011101",
      "ndc_label_name": "Asmanex HFA Aerosol 50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00085222201",
      "ndc_label_name": "Asmanex HFA Aerosol 50 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927505100",
      "ndc_label_name": "Asparagine Monohydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927271700",
      "ndc_label_name": "Asparagine Monohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779006101",
      "ndc_label_name": "Aspartame (For Compounding) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779006108",
      "ndc_label_name": "Aspartame (For Compounding) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779006104",
      "ndc_label_name": "Aspartame (For Compounding) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552077409",
      "ndc_label_name": "Aspartame (For Compounding) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779006107",
      "ndc_label_name": "Aspartame (For Compounding) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779006109",
      "ndc_label_name": "Aspartame (For Compounding) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309801",
      "ndc_label_name": "Aspartame (For Compounding) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779006105",
      "ndc_label_name": "Aspartame (For Compounding) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309804",
      "ndc_label_name": "Aspartame (For Compounding) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309805",
      "ndc_label_name": "Aspartame (For Compounding) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309808",
      "ndc_label_name": "Aspartame (For Compounding) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452076201",
      "ndc_label_name": "Aspartame (For Compounding) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779309807",
      "ndc_label_name": "Aspartame (For Compounding) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452076202",
      "ndc_label_name": "Aspartame (For Compounding) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927113400",
      "ndc_label_name": "Aspartame (For Compounding) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552077404",
      "ndc_label_name": "Aspartame (For Compounding) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779309809",
      "ndc_label_name": "Aspartame (For Compounding) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452076203",
      "ndc_label_name": "Aspartame (For Compounding) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452076204",
      "ndc_label_name": "Aspartame (For Compounding) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991117505",
      "ndc_label_name": "Aspartame (Nutrasweet) POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991117503",
      "ndc_label_name": "Aspartame (Nutrasweet) POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991117502",
      "ndc_label_name": "Aspartame (Nutrasweet) POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991117501",
      "ndc_label_name": "Aspartame (Nutrasweet) POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991117504",
      "ndc_label_name": "Aspartame (Nutrasweet) POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927523000",
      "ndc_label_name": "Aspartic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840540804",
      "ndc_label_name": "Aspen Pollen Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840540802",
      "ndc_label_name": "Aspen Pollen Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840560405",
      "ndc_label_name": "Aspergillus fumigat (Diagnost) Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991117602",
      "ndc_label_name": "Aspirin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452076002",
      "ndc_label_name": "Aspirin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452076006",
      "ndc_label_name": "Aspirin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452076003",
      "ndc_label_name": "Aspirin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452076001",
      "ndc_label_name": "Aspirin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552017506",
      "ndc_label_name": "Aspirin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991117601",
      "ndc_label_name": "Aspirin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452076005",
      "ndc_label_name": "Aspirin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927115700",
      "ndc_label_name": "Aspirin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991117604",
      "ndc_label_name": "Aspirin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991117606",
      "ndc_label_name": "Aspirin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991117605",
      "ndc_label_name": "Aspirin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904705699",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559085060",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714096401",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571027460",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598033960",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162059606",
      "ndc_label_name": "Aspirin-Dipyridamole ER CAPSULE EXTENDED RELEASE 12 HOUR 25-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291011660",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884000702",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62175033035",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407027160",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462040560",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73457041580",
      "ndc_label_name": "Aspirin-Omeprazole Tablet Delayed Release 81-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64950042630",
      "ndc_label_name": "Aspirin-Omeprazole Tablet Delayed Release 81-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335062460",
      "ndc_label_name": "Aspruzyo Sprinkle Packet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08317600001",
      "ndc_label_name": "Assure Titanium Blood Glucose Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08317600050",
      "ndc_label_name": "Assure Titanium Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08317600100",
      "ndc_label_name": "Assure Titanium Strip In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00469064773",
      "ndc_label_name": "Astagraf XL CAPSULE EXTENDED RELEASE 24 HOUR 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00469067773",
      "ndc_label_name": "Astagraf XL CAPSULE EXTENDED RELEASE 24 HOUR 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00469068773",
      "ndc_label_name": "Astagraf XL CAPSULE EXTENDED RELEASE 24 HOUR 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67754000012",
      "ndc_label_name": "AstaMed MYO CAPSULE ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927348100",
      "ndc_label_name": "Astragalus Root POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55495012501",
      "ndc_label_name": "Atabex OB Tablet 29-1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559065090",
      "ndc_label_name": "Atacand HCT Tablet 16-12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559065190",
      "ndc_label_name": "Atacand HCT Tablet 32-12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559065290",
      "ndc_label_name": "Atacand HCT Tablet 32-25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559064230",
      "ndc_label_name": "Atacand Tablet 16 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559064290",
      "ndc_label_name": "Atacand Tablet 16 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999098830",
      "ndc_label_name": "Atacand Tablet 32 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559064330",
      "ndc_label_name": "Atacand Tablet 32 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559064390",
      "ndc_label_name": "Atacand Tablet 32 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559064030",
      "ndc_label_name": "Atacand Tablet 4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356042730",
      "ndc_label_name": "Atacand Tablet 8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559064130",
      "ndc_label_name": "Atacand Tablet 8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714086001",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385092060",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093552606",
      "ndc_label_name": "Atazanavir Sulfate CAPSULE 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722065360",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862071160",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097044403",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238113606",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714086101",
      "ndc_label_name": "Atazanavir Sulfate Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407017260",
      "ndc_label_name": "Atazanavir Sulfate Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862071260",
      "ndc_label_name": "Atazanavir Sulfate Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093552706",
      "ndc_label_name": "Atazanavir Sulfate CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097044503",
      "ndc_label_name": "Atazanavir Sulfate Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722065460",
      "ndc_label_name": "Atazanavir Sulfate Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385092160",
      "ndc_label_name": "Atazanavir Sulfate Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238113706",
      "ndc_label_name": "Atazanavir Sulfate Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862071330",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714086201",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407017330",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722065530",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093552856",
      "ndc_label_name": "Atazanavir Sulfate CAPSULE 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518136500",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238113803",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385092230",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518283200",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097044602",
      "ndc_label_name": "Atazanavir Sulfate Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00430097903",
      "ndc_label_name": "Atelvia TABLET DELAYED RELEASE 35 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452002003",
      "ndc_label_name": "Atenolol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779026205",
      "ndc_label_name": "Atenolol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452002002",
      "ndc_label_name": "Atenolol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779026203",
      "ndc_label_name": "Atenolol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452002005",
      "ndc_label_name": "Atenolol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779026204",
      "ndc_label_name": "Atenolol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927246700",
      "ndc_label_name": "Atenolol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552091404",
      "ndc_label_name": "Atenolol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991282103",
      "ndc_label_name": "Atenolol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452002001",
      "ndc_label_name": "Atenolol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991282102",
      "ndc_label_name": "Atenolol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452002004",
      "ndc_label_name": "Atenolol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991282101",
      "ndc_label_name": "Atenolol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717290",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093075301",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090341000",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041210",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093075305",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378075701",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378075710",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353088760",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090526600",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044803",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631103",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353098660",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044800",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717230",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041201",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090573800",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079068520",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090526603",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862017001",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090573803",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090341005",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041205",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079068501",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429002690",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304062310",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631105",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002992",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631100",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959025860",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044805",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162232600",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382002401",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629262603",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304062301",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788707103",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002113806",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002113800",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090341003",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518088200",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788707101",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980043910",
      "ndc_label_name": "Atenolol TABLET 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980043901",
      "ndc_label_name": "Atenolol TABLET 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518293900",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429002610",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760064290",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090573805",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162232609",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919085490",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382002410",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267002991",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919085430",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629262601",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189015290",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959025830",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862017099",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629262604",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518293901",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788707106",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518088202",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002113803",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518293902",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788707109",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629262602",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834028300",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063080590",
      "ndc_label_name": "Atenolol TABLET 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571043011",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717045",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093078701",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717030",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378021801",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093078710",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063095230",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083330",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063080501",
      "ndc_label_name": "Atenolol TABLET 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083345",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904718761",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041001",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717090",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378021810",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063095290",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090051400",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063080530",
      "ndc_label_name": "Atenolol TABLET 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999045490",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041005",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999045460",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083380",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999045410",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083360",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090341104",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429002790",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090051402",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041010",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090051406",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999045400",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090341100",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090341102",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090693500",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760016390",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090624102",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090051405",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090540802",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090051404",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090624105",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090760300",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959046330",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919027990",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429002710",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090540805",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919027960",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090341105",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079075901",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700075530",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002110803",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187053710",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760025690",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079075920",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304062101",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090624100",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687060501",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544024030",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002110806",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862016899",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760043790",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959046301",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788778406",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304062110",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687060511",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544024080",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919091471",
      "ndc_label_name": "Atenolol TABLET 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382002201",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919027930",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959046360",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788852703",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629178503",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760078790",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518039902",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544024060",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788787601",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629178501",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002110800",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788852706",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788852701",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382002210",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205009690",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544024092",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788873906",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980043701",
      "ndc_label_name": "Atenolol TABLET 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760043730",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788852709",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788873909",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788787603",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610085745",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788778403",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518039900",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980043710",
      "ndc_label_name": "Atenolol TABLET 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629178502",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189039630",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518300700",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788787606",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610085753",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788787609",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518300701",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862016801",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544024045",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788873901",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610065830",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934017730",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610085780",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610065892",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610065845",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788778409",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788778401",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610085760",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189014660",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610065860",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162232409",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162232400",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834028100",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788873903",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934017760",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610065880",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189014630",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189039690",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189014690",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610085730",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083445",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041105",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717106",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717145",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093075201",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378023101",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093075210",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378023110",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090304301",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353093960",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717130",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353093980",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717110",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571043111",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041101",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356073730",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090523308",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044208",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717192",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044207",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717160",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063076590",
      "ndc_label_name": "Atenolol TABLET 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300041110",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353093930",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090536300",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090536307",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083073",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090304307",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717190",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083060",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063076530",
      "ndc_label_name": "Atenolol TABLET 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044200",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090536701",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090536308",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090304304",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090304308",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083430",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090304300",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083480",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090536708",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090574101",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090784700",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090536700",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090536301",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083460",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090536707",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353093945",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079068420",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090574104",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079068401",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959025320",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700075430",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083473",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090677900",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353093973",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959025300",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002100403",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959025340",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002100406",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919025730",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044201",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959025330",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090536304",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760064390",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760016490",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489052910",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760016430",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919025790",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044204",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429002510",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090574100",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980043810",
      "ndc_label_name": "Atenolol TABLET 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788761609",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348014230",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382002310",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919093530",
      "ndc_label_name": "Atenolol TABLET 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090281100",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760005990",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429002590",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645058554",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518303600",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760064330",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788761601",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919093590",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090574107",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304062201",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862016901",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518037900",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934014230",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919066430",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788883406",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187020130",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090574108",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382002301",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518035102",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518303601",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610086180",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980043801",
      "ndc_label_name": "Atenolol TABLET 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788883409",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304062210",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002100400",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788761603",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518037901",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205022930",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014490",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205049630",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162232500",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862016999",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518037902",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788883403",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610086160",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788761606",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934021930",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610086145",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014430",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788883401",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518286600",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205022990",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162232509",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518303602",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834028200",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335095404",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008005230",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610086130",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610086173",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189013530",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552144003",
      "ndc_label_name": "Atenolol+SyrSpend SF Suspension 1 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300040101",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 100-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710116801",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 100-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289098830",
      "ndc_label_name": "Atenolol-Chlorthalidone TABLET 100-25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591578301",
      "ndc_label_name": "Atenolol-Chlorthalidone TABLET 100-25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714093701",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 100-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135073401",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 100-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518244600",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 100-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954039110",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 100-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710116701",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135073301",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591578201",
      "ndc_label_name": "Atenolol-Chlorthalidone TABLET 50-25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300040001",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954039010",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714093601",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353014909",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289099360",
      "ndc_label_name": "Atenolol-Chlorthalidone TABLET 50-25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289099330",
      "ndc_label_name": "Atenolol-Chlorthalidone TABLET 50-25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289099390",
      "ndc_label_name": "Atenolol-Chlorthalidone TABLET 50-25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641600001",
      "ndc_label_name": "Ativan SOLUTION 2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641600101",
      "ndc_label_name": "Ativan SOLUTION 2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641600010",
      "ndc_label_name": "Ativan SOLUTION 2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641600125",
      "ndc_label_name": "Ativan SOLUTION 2 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641600301",
      "ndc_label_name": "Ativan SOLUTION 4 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641600201",
      "ndc_label_name": "Ativan SOLUTION 4 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641600325",
      "ndc_label_name": "Ativan SOLUTION 4 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641600210",
      "ndc_label_name": "Ativan SOLUTION 4 MG/ML INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840576905",
      "ndc_label_name": "Atlantic Cod (Diagnostic) Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840577605",
      "ndc_label_name": "Atlantic Salmon (Diagnostic) Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840577405",
      "ndc_label_name": "Atlantic/Eastern Oyster(Diagn) Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722071430",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35573041530",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162254103",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714075501",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380047201",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093354256",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407010030",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111051930",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462026530",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291006430",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505283003",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980037303",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993004030",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993004630",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093354856",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35573042130",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291007030",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090746300",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162254703",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714076101",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090614400",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407010630",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505283603",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722072030",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380047801",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462027130",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111056430",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980037903",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291006530",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722071530",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111052030",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714075601",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093354356",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 18 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980037403",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 18 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380047301",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162254203",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35573041630",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462026630",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 18 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407010130",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505283103",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714075701",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268005711",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093354456",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268005713",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090651200",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722071630",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090670300",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993004230",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111052830",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291006630",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35573041730",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407010230",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505283203",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687056711",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462026730",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687056721",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090734200",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980037503",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162254303",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380047401",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090423600",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722071730",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093354556",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291006730",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714075801",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335303301",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904690804",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090746200",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268005813",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090614300",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462026830",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980037603",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35573041830",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090628900",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162254403",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687032625",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111052130",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090651300",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407010330",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687032695",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268005811",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993004330",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505283303",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380047501",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090625400",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093354656",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714075901",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35573041930",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407010430",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090644400",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291006830",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268005913",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505283403",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090739700",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722071830",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993004430",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380047601",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268005911",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162254503",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462026930",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111052230",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980037703",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090612700",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093354756",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35573042030",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714076001",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722071930",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090651100",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291006930",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980037803",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380047701",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111056330",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162254603",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505283503",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462027030",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407010530",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993004530",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72057000101",
      "ndc_label_name": "Atopaderm Cream External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "99207012010",
      "ndc_label_name": "Atopiclair Cream External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46287003001",
      "ndc_label_name": "Atorvaliq Suspension 20 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10695016650",
      "ndc_label_name": "Atorvastatin Calcium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144015050",
      "ndc_label_name": "Atorvastatin Calcium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927515300",
      "ndc_label_name": "Atorvastatin Calcium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440712560",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093505698",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904629006",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093505610",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714017301",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378395077",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571013609",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378395005",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781538192",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571013650",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090125500",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440712530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722042405",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440712590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714017302",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714017303",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571013610",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722042410",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090518400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440712581",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385094090",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904629061",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714087403",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729004415",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714087402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598083005",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090518401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440712585",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598009890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135064910",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729004417",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658050790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722042490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090563600",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090757401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714087401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090125400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658050710",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063047430",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571017290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385094001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090757402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009311",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385094005",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090125501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598009805",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090549701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090125401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385094011",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090772000",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111012105",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571017210",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090563601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079020801",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090757400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353011545",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009315",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505257809",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353011560",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651060690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084009711",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079020820",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045110",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353012060",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154663500",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760059330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598083090",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762015502",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382024916",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877051110",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651060699",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090518402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762015501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919095630",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090648000",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505257808",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788400806",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788400809",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760066630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090757500",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429032310",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304082705",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090772001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62175089046",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788761801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788797903",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760090390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090772100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919095690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739001810",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090772002",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877051190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788761806",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788797909",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62175089043",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407007890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304082790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788790006",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407007810",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084009701",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788763006",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788838901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629846901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788761809",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071091430",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788838906",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111012190",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645048054",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788763009",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788884206",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877051105",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788839503",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180063502",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788955603",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700087730",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788400801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788790003",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377002711",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180063509",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788839506",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382024910",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097094415",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429032390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788763003",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788839501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518194600",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788400803",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788839509",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788761803",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377007711",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788867209",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788790009",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788840901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205080290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788763001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788865603",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788790001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518329800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788884203",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788797901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788859109",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205002290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788838903",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788865606",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788840903",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162155409",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710177700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788797906",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788867203",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789015330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788840906",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788865609",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097089715",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771045110",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934048230",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788838909",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788867206",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804014490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788840909",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097094405",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756024751",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788868406",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934048290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756024712",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189022690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377002713",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788868403",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934007030",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205080230",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377007713",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189022630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603040301",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603040302",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518022402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788868409",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771045190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335238802",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518194601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205002205",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009000110",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834025590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710177709",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788884209",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756024790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610016960",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205024630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603028201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603028202",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804014430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009000190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097089705",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189053190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834025550",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205002299",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518194602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834025501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603028203",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009017610",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093505998",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093505910",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571013710",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378395177",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714087503",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904629161",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440712690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440712681",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440712630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378395105",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722042510",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385094105",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658050810",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571013709",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781538292",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135065005",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440712660",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440712685",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722042590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353090445",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385094101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722042505",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904629106",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714017403",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714017401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714087501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598009990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353090460",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353089245",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571017310",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571013750",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353085109",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714017402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571017390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090518101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598009905",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090738602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598083190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729004515",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353089209",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714087502",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049630",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090648102",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090125700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090772201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090518200",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598083105",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090125800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729004517",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353090409",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090772200",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090125701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762015601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090772202",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090563401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090563400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658050890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090125801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045205",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090488001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505257908",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090772300",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090660400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090648200",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385094111",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090648100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009411",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090518100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919025890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436998803",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090738600",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090660401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385094190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090660402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111012290",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090752801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739002010",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407007905",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090738601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079020920",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063049660",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090738700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154663400",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090752802",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382025010",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51655092152",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760088390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090518102",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090752800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651060799",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090752900",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788787403",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700087130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079020901",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788763109",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090648101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629847001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762015602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407007990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788787406",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304082805",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505257909",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788787401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009415",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788763101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919063230",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111012205",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788787409",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877051205",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877051290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788837006",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651060790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788837003",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62175089143",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788798601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518087800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877051210",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084009801",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788841609",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629847101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788841606",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62175089146",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788862503",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518197701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645048154",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084009811",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518333900",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071091530",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788861301",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304082890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788868303",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518197702",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788862501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180063602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518341400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382025016",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788868309",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788861306",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788868306",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518263500",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788862506",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180063609",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756024812",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788798606",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788869309",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788861309",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377002811",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710177509",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097094505",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788763103",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335105102",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788798609",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097094512",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788868301",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335101001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934061430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377007813",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788763106",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335240408",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788837001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377007811",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788869301",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610074415",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335105101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518197700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788798603",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610011645",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788841601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710177500",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788968303",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162171203",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610018015",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934006990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788837009",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162171202",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788869303",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934006930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518018602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162171209",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610018045",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610002245",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788841603",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603028301",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097089805",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205024730",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518284300",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189058790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162171204",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610018060",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788861303",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834025690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377002813",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335105104",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518303700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603040401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518087803",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788862509",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804005430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518332600",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335240403",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205079130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603040402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934029630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009000210",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788869306",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804016190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335101003",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610002260",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205079190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834025650",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335105105",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610074453",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097089812",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771045205",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610074470",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162155505",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610011660",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804005490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162155509",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205002390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756024851",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804016130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189029190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610018030",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603028302",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756024890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771045290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610074445",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934061490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162171206",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335105103",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162171207",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335105106",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834025601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610074430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009017710",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610074460",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189058730",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205002305",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205002399",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603028303",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440712760",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440712730",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440712785",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093505810",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093505898",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378395205",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353028045",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440712781",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714017502",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781538492",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571013810",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378395277",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440712790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135065110",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353082645",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714017501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571017410",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904629261",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714087601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904629206",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714087602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571013809",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353095930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729004615",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353028745",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598010190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353082145",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714017503",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385094201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571013850",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090343800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658050910",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353087330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090520800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090126100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714087603",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063045330",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729004617",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090563200",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658050990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598083290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090633301",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090738500",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722042605",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353028730",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385094211",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090591500",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385094205",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090591600",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090633302",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090772602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722042610",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353028760",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353028715",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090591501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571017490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090680002",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090738401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090780700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722042690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353082130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353095945",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090633300",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353082115",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090738400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090780601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009515",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385094290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353082615",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090126101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090644002",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353082160",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090738402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154664600",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54458088116",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353028015",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598010105",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090520701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090689001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353087345",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090772600",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760082930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505258009",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353082660",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090126000",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090520702",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407008010",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090520700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090780600",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919030390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304082905",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353087315",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090563201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090644000",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760070930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090592101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436998901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180063709",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304082990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353095915",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090592100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090644001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62175089241",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090680100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111012390",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645056854",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739003610",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598083205",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090772700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090644100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62175089246",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090772601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429032505",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788809403",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877051390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090126001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407008090",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090680000",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877051305",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090780602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084009911",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788831503",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084009901",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090343801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111012305",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045310",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788831501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009511",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382025116",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097094605",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180063702",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090633400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762015701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651060899",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377002911",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079021020",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788779909",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377007911",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788779906",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090680001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760072630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760097930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518132201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651060890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097089915",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205026490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788857409",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090689000",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760073430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788829803",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518132202",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762015702",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377002913",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335076701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788888703",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090689100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919030330",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788831509",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518327300",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505258008",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518132204",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335076703",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756024951",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788809406",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377007913",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710177209",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760055830",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756024990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335971103",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335132202",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079021001",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788809409",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934061590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934034230",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760090530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610074515",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610016830",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335972305",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760088230",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788829809",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205076530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335101103",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760090590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771045310",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162223809",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335972307",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788779903",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788888701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335972304",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335972301",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187010990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009017810",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205002405",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189055790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788809401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788888706",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610016330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610016815",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877051310",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710177200",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009000310",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603040502",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788829801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756024912",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610074530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610016845",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071091630",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934061530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610074545",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804002690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788831506",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335972302",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610074560",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834025701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382025110",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610016345",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189055730",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834025790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788888709",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610016860",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205002490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771045390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788779901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603028401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205002499",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603040501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097089905",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834025750",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788829806",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804005630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934009130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097094615",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610016315",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205073130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603028402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205076590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603028403",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335972303",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335972306",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008008090",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610074553",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093505705",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714087702",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714087701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093505798",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781538892",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378395305",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440712830",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904629304",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571013950",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658051010",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729004715",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440712885",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135065305",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378395377",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440712890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722042790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658051090",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385094311",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722042705",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571013909",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714017601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440712860",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571013910",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353032115",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571017510",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353032160",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353081530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714017602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714017603",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440712881",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714087703",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353081515",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353081545",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353082745",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353081560",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385094301",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722042710",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385094305",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729004716",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353098115",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598083305",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353084345",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353082715",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571017590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598010305",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353032145",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42385094390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090126400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090605400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353098130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353084315",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353082753",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090606100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353084330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353032130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090126501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090772400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353098315",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090126401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353082760",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090606101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090735801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353081579",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090605700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651060999",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090126500",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090529800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353084360",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090753202",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090735802",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353082730",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090650600",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629847201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090529801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090563900",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353098145",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762015801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154438406",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353098160",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090697000",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877051410",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090606102",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090563901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353098345",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762015802",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651060990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353098330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111012405",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788813209",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090772500",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090605401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598010390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919053130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429032605",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598083390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877051405",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756025051",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009611",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090753200",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090735900",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187090790",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505267108",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090605701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788813203",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610003615",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304083090",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090753201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090753300",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084059095",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505267109",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090735800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377003014",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610003630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382025216",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090772401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079021103",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788899101",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180063809",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045405",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756025090",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610063360",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788813201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090772402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407008190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788899106",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788899109",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268009612",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335058303",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189053790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788813206",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111012490",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377008011",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097094705",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407008105",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610009430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771045405",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377003012",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919053190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62175089746",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518151401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934051330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645049554",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009000410",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710177000",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518151400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62175089741",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739003733",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335058302",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205009890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518330400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180063802",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610003660",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710177009",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187065690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335058301",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610009445",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610017015",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205033530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610017060",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610063330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205033590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304083005",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205002599",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610074660",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610017030",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610074653",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603028501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205002590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610003645",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877051490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603040602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603028502",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610017045",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162155609",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610074615",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603040601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610063315",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084059025",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610074645",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009017910",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610063345",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603028503",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189029530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382025210",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205002505",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788899103",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834025801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097091105",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834025850",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097091112",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834025890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097094712",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771045490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377008013",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610009415",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610009460",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610074630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904706425",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121089805",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687053440",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121088842",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904745925",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121179620",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121089818",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121179610",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904706453",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121095608",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462042169",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121089842",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011911",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904745953",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121101605",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268008611",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10702022321",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121101618",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722062921",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121101642",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689006218",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687053436",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135052845",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135052824",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011912",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714090001",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462042121",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739020303",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135052809",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687053478",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739020302",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748029901",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162069388",
      "ndc_label_name": "Atovaquone SUSPENSION 750 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268008612",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689006242",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73141010405",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452025287",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603024801",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407064287",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81033010442",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73141010442",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81033010405",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81033010422",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130209",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063052224",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440704001",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063052268",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440704065",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063039314",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378416201",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063052220",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298009",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130202",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298001",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063052269",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063039320",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063052207",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063052214",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130201",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001024514",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130208",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298007",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063052273",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130203",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130204",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130200",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130206",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298003",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298008",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760049811",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298000",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462040444",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298004",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130205",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130207",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187087924",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407086901",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298005",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993006002",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298002",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407086924",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090298006",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993006027",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118040402",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760049804",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187087916",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462040467",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760049813",
      "ndc_label_name": "Atovaquone-Proguanil HCl Tablet 250-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001024500",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001024515",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462040401",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 250-100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462040201",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 62.5-25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378416001",
      "ndc_label_name": "Atovaquone-Proguanil HCl TABLET 62.5-25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15584010101",
      "ndc_label_name": "Atripla Tablet 600-200-300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090098000",
      "ndc_label_name": "Atripla Tablet 600-200-300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11704010701",
      "ndc_label_name": "AtroPen Solution Auto-Injector 0.25 MG/0.3ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11704010401",
      "ndc_label_name": "AtroPen Solution Auto-Injector 0.5 MG/0.7ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11704010501",
      "ndc_label_name": "AtroPen Solution Auto-Injector 1 MG/0.7ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11704010601",
      "ndc_label_name": "AtroPen Solution Auto-Injector 2 MG/0.7ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927100100",
      "ndc_label_name": "Atropine Sulfate Monohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779226701",
      "ndc_label_name": "Atropine Sulfate Monohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592004925",
      "ndc_label_name": "Atropine Sulfate Monohydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592004905",
      "ndc_label_name": "Atropine Sulfate Monohydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779226703",
      "ndc_label_name": "Atropine Sulfate Monohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552139102",
      "ndc_label_name": "Atropine Sulfate Monohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284202",
      "ndc_label_name": "Atropine Sulfate Monohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592004922",
      "ndc_label_name": "Atropine Sulfate Monohydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779226705",
      "ndc_label_name": "Atropine Sulfate Monohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779226704",
      "ndc_label_name": "Atropine Sulfate Monohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284201",
      "ndc_label_name": "Atropine Sulfate Monohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592004911",
      "ndc_label_name": "Atropine Sulfate Monohydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779226708",
      "ndc_label_name": "Atropine Sulfate Monohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144030505",
      "ndc_label_name": "Atropine Sulfate Monohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552139104",
      "ndc_label_name": "Atropine Sulfate Monohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592004910",
      "ndc_label_name": "Atropine Sulfate Monohydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592004901",
      "ndc_label_name": "Atropine Sulfate Monohydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284203",
      "ndc_label_name": "Atropine Sulfate Monohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011835",
      "ndc_label_name": "Atropine Sulfate Ointment 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208082555",
      "ndc_label_name": "Atropine Sulfate Ointment 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552015604",
      "ndc_label_name": "Atropine Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552015602",
      "ndc_label_name": "Atropine Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729052563",
      "ndc_label_name": "Atropine Sulfate Solution 0.4 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517100425",
      "ndc_label_name": "Atropine Sulfate Solution 0.4 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517100401",
      "ndc_label_name": "Atropine Sulfate Solution 0.4 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641627401",
      "ndc_label_name": "Atropine Sulfate Solution 0.4 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729052508",
      "ndc_label_name": "Atropine Sulfate Solution 0.4 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641627425",
      "ndc_label_name": "Atropine Sulfate Solution 0.4 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069063125",
      "ndc_label_name": "Atropine Sulfate Solution 0.4 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065081701",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065081702",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069058201",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090310400",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505622600",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478021502",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069071601",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090700000",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478021515",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090731300",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603026402",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069058101",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76478001502",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478021505",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76478001505",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219174903",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090629500",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219174802",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76478001515",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505622601",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219175008",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756065125",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069058301",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505622602",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756065225",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756065335",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603026401",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82260000101",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641627501",
      "ndc_label_name": "Atropine Sulfate Solution 1 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517100101",
      "ndc_label_name": "Atropine Sulfate Solution 1 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729052608",
      "ndc_label_name": "Atropine Sulfate Solution 1 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517100125",
      "ndc_label_name": "Atropine Sulfate Solution 1 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641627525",
      "ndc_label_name": "Atropine Sulfate Solution 1 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729052663",
      "ndc_label_name": "Atropine Sulfate Solution 1 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069064125",
      "ndc_label_name": "Atropine Sulfate Solution 1 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641625110",
      "ndc_label_name": "Atropine Sulfate Solution 8 MG/20ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729051243",
      "ndc_label_name": "Atropine Sulfate Solution 8 MG/20ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641600601",
      "ndc_label_name": "Atropine Sulfate Solution 8 MG/20ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069048101",
      "ndc_label_name": "Atropine Sulfate Solution 8 MG/20ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641600610",
      "ndc_label_name": "Atropine Sulfate Solution 8 MG/20ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641625101",
      "ndc_label_name": "Atropine Sulfate Solution 8 MG/20ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729051205",
      "ndc_label_name": "Atropine Sulfate Solution 8 MG/20ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323058003",
      "ndc_label_name": "Atropine Sulfate Solution 8 MG/20ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069048110",
      "ndc_label_name": "Atropine Sulfate Solution 8 MG/20ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323058020",
      "ndc_label_name": "Atropine Sulfate Solution 8 MG/20ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729048490",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 0.5 MG/5ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121170501",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 0.5 MG/5ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121170507",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 0.5 MG/5ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409491011",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 0.5 MG/5ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409491034",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 0.5 MG/5ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729048445",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 1 MG/10ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409163015",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 1 MG/10ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090592400",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 1 MG/10ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409163010",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 1 MG/10ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121170601",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 1 MG/10ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409491111",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 1 MG/10ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090313800",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 1 MG/10ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409491134",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 1 MG/10ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518312000",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 1 MG/10ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090218100",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 1 MG/10ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253040091",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 1 MG/10ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121170602",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 1 MG/10ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76329333901",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 1 MG/10ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121170604",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 1 MG/10ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253040030",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 1 MG/10ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76329334001",
      "ndc_label_name": "Atropine Sulfate Solution Prefilled Syringe 1 MG/10ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00597008717",
      "ndc_label_name": "Atrovent HFA Aerosol Solution 17 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090096100",
      "ndc_label_name": "Atrovent HFA Aerosol Solution 17 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927240500",
      "ndc_label_name": "Attapulgite POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82228071228",
      "ndc_label_name": "Attruby Tablet Therapy Pack 356 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58468021001",
      "ndc_label_name": "Aubagio Tablet 14 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58468021002",
      "ndc_label_name": "Aubagio Tablet 14 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58468021004",
      "ndc_label_name": "Aubagio Tablet 14 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58468021101",
      "ndc_label_name": "Aubagio Tablet 7 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58468021104",
      "ndc_label_name": "Aubagio Tablet 7 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58468021102",
      "ndc_label_name": "Aubagio Tablet 7 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50102022023",
      "ndc_label_name": "Aubra EQ Tablet 0.1-20 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50102022021",
      "ndc_label_name": "Aubra EQ Tablet 0.1-20 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50102012001",
      "ndc_label_name": "Aubra Tablet 0.1-20 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50102012003",
      "ndc_label_name": "Aubra Tablet 0.1-20 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50102012010",
      "ndc_label_name": "Aubra Tablet 0.1-20 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50102012048",
      "ndc_label_name": "Aubra Tablet 0.1-20 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70461080040",
      "ndc_label_name": "Audenz Emulsion Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70461080041",
      "ndc_label_name": "Audenz Emulsion Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70461070004",
      "ndc_label_name": "Audenz Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70461070003",
      "ndc_label_name": "Audenz Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964000354",
      "ndc_label_name": "Augmentin ES-600 Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598000351",
      "ndc_label_name": "Augmentin ES-600 Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598000354",
      "ndc_label_name": "Augmentin ES-600 Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598000369",
      "ndc_label_name": "Augmentin ES-600 Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999021320",
      "ndc_label_name": "Augmentin Tablet 500-125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002104",
      "ndc_label_name": "Augmentin Tablet 500-125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002120",
      "ndc_label_name": "Augmentin Tablet 500-125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598000614",
      "ndc_label_name": "Augmentin Tablet 500-125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002121",
      "ndc_label_name": "Augmentin Tablet 500-125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267044415",
      "ndc_label_name": "Augmentin Tablet 500-125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002114",
      "ndc_label_name": "Augmentin Tablet 500-125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002130",
      "ndc_label_name": "Augmentin Tablet 500-125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959002115",
      "ndc_label_name": "Augmentin Tablet 500-125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267099220",
      "ndc_label_name": "Augmentin Tablet 500-125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003416014",
      "ndc_label_name": "Augtyro Capsule 160 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003416060",
      "ndc_label_name": "Augtyro Capsule 160 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003404012",
      "ndc_label_name": "Augtyro Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003404060",
      "ndc_label_name": "Augtyro Capsule 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862093574",
      "ndc_label_name": "Aurovela 1.5/30 Tablet 1.5-30 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862093521",
      "ndc_label_name": "Aurovela 1.5/30 Tablet 1.5-30 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862093988",
      "ndc_label_name": "Aurovela 1/20 Tablet 1-20 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862093921",
      "ndc_label_name": "Aurovela 1/20 Tablet 1-20 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862093488",
      "ndc_label_name": "Aurovela 24 FE Tablet 1-20 MG-MCG(24) Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862093487",
      "ndc_label_name": "Aurovela 24 FE Tablet 1-20 MG-MCG(24) Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862094188",
      "ndc_label_name": "Aurovela Fe 1.5/30 Tablet 1.5-30 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862094187",
      "ndc_label_name": "Aurovela Fe 1.5/30 Tablet 1.5-30 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862094088",
      "ndc_label_name": "Aurovela FE 1/20 Tablet 1-20 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862094087",
      "ndc_label_name": "Aurovela FE 1/20 Tablet 1-20 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59922063101",
      "ndc_label_name": "Auryxia Tablet 1 GM 210 MG(Fe) Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68546017260",
      "ndc_label_name": "Austedo TABLET 12 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68546017060",
      "ndc_label_name": "Austedo TABLET 6 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68546017160",
      "ndc_label_name": "Austedo TABLET 9 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68546047729",
      "ndc_label_name": "Austedo XR Patient Titration Tablet Extended Release Therapy Pack 12 & 18 & 24 & 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68546049052",
      "ndc_label_name": "Austedo XR Patient Titration Tablet Extended Release Therapy Pack 6 & 12 & 24 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68546047156",
      "ndc_label_name": "Austedo XR Tablet Extended Release 24 Hour 12 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68546047956",
      "ndc_label_name": "Austedo XR Tablet Extended Release 24 Hour 18 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68546047256",
      "ndc_label_name": "Austedo XR Tablet Extended Release 24 Hour 24 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68546047356",
      "ndc_label_name": "Austedo XR Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68546047456",
      "ndc_label_name": "Austedo XR Tablet Extended Release 24 Hour 36 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68546047556",
      "ndc_label_name": "Austedo XR Tablet Extended Release 24 Hour 42 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68546047656",
      "ndc_label_name": "Austedo XR Tablet Extended Release 24 Hour 48 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68546047056",
      "ndc_label_name": "Austedo XR Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779758501",
      "ndc_label_name": "Autoclave Air Filter",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779907402",
      "ndc_label_name": "Autoclave Paper 36\" x 36\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779770101",
      "ndc_label_name": "Autoclave Printer Paper",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81968004560",
      "ndc_label_name": "Auvelity Tablet Extended Release 45-105 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81968004530",
      "ndc_label_name": "Auvelity Tablet Extended Release 45-105 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60842002102",
      "ndc_label_name": "Auvi-Q Solution Auto-Injector 0.1 MG/0.1ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60842002101",
      "ndc_label_name": "Auvi-Q Solution Auto-Injector 0.1 MG/0.1ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60842002201",
      "ndc_label_name": "Auvi-Q Solution Auto-Injector 0.15 MG/0.15ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60842002202",
      "ndc_label_name": "Auvi-Q Solution Auto-Injector 0.15 MG/0.15ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60842002302",
      "ndc_label_name": "Auvi-Q Solution Auto-Injector 0.3 MG/0.3ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60842002301",
      "ndc_label_name": "Auvi-Q Solution Auto-Injector 0.3 MG/0.3ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024585530",
      "ndc_label_name": "Avalide TABLET 150-12.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356037415",
      "ndc_label_name": "Avalide Tablet 150-12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356037430",
      "ndc_label_name": "Avalide Tablet 150-12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356040630",
      "ndc_label_name": "Avalide Tablet 300-12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024585630",
      "ndc_label_name": "Avalide TABLET 300-12.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105050309",
      "ndc_label_name": "Avapro TABLET 150 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024585130",
      "ndc_label_name": "Avapro TABLET 150 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105050315",
      "ndc_label_name": "Avapro TABLET 150 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105050301",
      "ndc_label_name": "Avapro TABLET 150 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105050303",
      "ndc_label_name": "Avapro TABLET 150 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105050306",
      "ndc_label_name": "Avapro TABLET 150 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105050403",
      "ndc_label_name": "Avapro TABLET 300 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024585230",
      "ndc_label_name": "Avapro TABLET 300 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105050406",
      "ndc_label_name": "Avapro TABLET 300 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105050409",
      "ndc_label_name": "Avapro TABLET 300 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105050415",
      "ndc_label_name": "Avapro TABLET 300 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105050401",
      "ndc_label_name": "Avapro TABLET 300 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024585090",
      "ndc_label_name": "Avapro Tablet 75 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67979051143",
      "ndc_label_name": "Aveed SOLUTION 750 MG/3ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75854060403",
      "ndc_label_name": "Averi Tablet 0.15-0.03 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75854060401",
      "ndc_label_name": "Averi Tablet 0.15-0.03 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555904558",
      "ndc_label_name": "Aviane TABLET 0.1-20 MG-MCG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555904579",
      "ndc_label_name": "Aviane TABLET 0.1-20 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187088928",
      "ndc_label_name": "Aviane TABLET 0.1-20 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991308301",
      "ndc_label_name": "Avicel PH 101 Micro Cellulose POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991200702",
      "ndc_label_name": "Avicel PH 105 Micro Cellulose POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991200701",
      "ndc_label_name": "Avicel PH 105 Micro Cellulose POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991200706",
      "ndc_label_name": "Avicel PH 105 Micro Cellulose POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43684020021",
      "ndc_label_name": "Avidoxy DK KIT 100 MG COMBINATION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43684020020",
      "ndc_label_name": "Avidoxy TABLET 100 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144030601",
      "ndc_label_name": "Aviptadil Acetate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71779062301",
      "ndc_label_name": "Avmapki Fakzynja Co-Pack Therapy Pack 0.8 & 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927282900",
      "ndc_label_name": "Avocado Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59627033304",
      "ndc_label_name": "Avonex Pen Auto-injector Kit 30 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59627022205",
      "ndc_label_name": "Avonex Prefilled Prefilled Syringe Kit 30 MCG/0.5ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456270001",
      "ndc_label_name": "Avycaz Solution Reconstituted 2.5 (2-0.5) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456270010",
      "ndc_label_name": "Avycaz SOLUTION RECONSTITUTED 2.5 (2-0.5) GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51285042410",
      "ndc_label_name": "Aygestin Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862084828",
      "ndc_label_name": "Ayuna Tablet 0.15-30 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862084888",
      "ndc_label_name": "Ayuna Tablet 0.15-30 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72064011030",
      "ndc_label_name": "Ayvakit Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72064012030",
      "ndc_label_name": "Ayvakit Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72064012530",
      "ndc_label_name": "Ayvakit Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72064013030",
      "ndc_label_name": "Ayvakit Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72064015030",
      "ndc_label_name": "Ayvakit Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090749400",
      "ndc_label_name": "Azactam Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003256016",
      "ndc_label_name": "Azactam Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003257016",
      "ndc_label_name": "Azactam Solution Reconstituted 2 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69597035460",
      "ndc_label_name": "Azalgia Capsule Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478030703",
      "ndc_label_name": "AzaSite SOLUTION 1 % OPHTHALMIC",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82584030703",
      "ndc_label_name": "AzaSite Solution 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452078304",
      "ndc_label_name": "AzaTHIOprine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452078301",
      "ndc_label_name": "AzaTHIOprine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552077905",
      "ndc_label_name": "AzaTHIOprine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452078303",
      "ndc_label_name": "AzaTHIOprine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779031203",
      "ndc_label_name": "AzaTHIOprine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927225800",
      "ndc_label_name": "AzaTHIOprine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779031204",
      "ndc_label_name": "AzaTHIOprine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552077904",
      "ndc_label_name": "AzaTHIOprine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779031206",
      "ndc_label_name": "AzaTHIOprine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991218903",
      "ndc_label_name": "AzaTHIOprine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452078302",
      "ndc_label_name": "AzaTHIOprine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991218904",
      "ndc_label_name": "AzaTHIOprine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452078305",
      "ndc_label_name": "AzaTHIOprine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552077902",
      "ndc_label_name": "AzaTHIOprine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991218901",
      "ndc_label_name": "AzaTHIOprine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143956601",
      "ndc_label_name": "AzaTHIOprine Sodium SOLUTION RECONSTITUTED 100 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291006301",
      "ndc_label_name": "azaTHIOprine Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682024101",
      "ndc_label_name": "azaTHIOprine Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219203701",
      "ndc_label_name": "azaTHIOprine Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382012001",
      "ndc_label_name": "azaTHIOprine Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789012930",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378100501",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571083501",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610012409",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084022901",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382000305",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407018201",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291007101",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462050201",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353074509",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877049301",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353074560",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030660",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219107601",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382000301",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877049305",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084022911",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219203601",
      "ndc_label_name": "azaTHIOprine Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682023101",
      "ndc_label_name": "azaTHIOprine Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382011901",
      "ndc_label_name": "azaTHIOprine Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71258001502",
      "ndc_label_name": "Azedra Dosimetric Solution 15 MCI/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71258001522",
      "ndc_label_name": "Azedra Therapeutic Solution 15 MCI/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927117900",
      "ndc_label_name": "Azelaic Acid FLAKES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552011205",
      "ndc_label_name": "Azelaic Acid FLAKES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51672138903",
      "ndc_label_name": "Azelaic Acid Gel 15 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162229702",
      "ndc_label_name": "Azelaic Acid Gel 15 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462062652",
      "ndc_label_name": "Azelaic Acid Gel 15 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "21922003814",
      "ndc_label_name": "Azelaic Acid Gel 15 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591213155",
      "ndc_label_name": "Azelaic Acid Gel 15 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781717250",
      "ndc_label_name": "Azelaic Acid Gel 15 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779326105",
      "ndc_label_name": "Azelaic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779326109",
      "ndc_label_name": "Azelaic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452002104",
      "ndc_label_name": "Azelaic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452002101",
      "ndc_label_name": "Azelaic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452002102",
      "ndc_label_name": "Azelaic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71052063820",
      "ndc_label_name": "Azelaic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991320202",
      "ndc_label_name": "Azelaic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144015925",
      "ndc_label_name": "Azelaic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927518800",
      "ndc_label_name": "Azelaic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991320203",
      "ndc_label_name": "Azelaic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452002103",
      "ndc_label_name": "Azelaic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991320201",
      "ndc_label_name": "Azelaic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052063801",
      "ndc_label_name": "Azelaic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052063805",
      "ndc_label_name": "Azelaic Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991320001",
      "ndc_label_name": "Azelastine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927500500",
      "ndc_label_name": "Azelastine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505057804",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.05 % OPHTHALMIC",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071810",
      "ndc_label_name": "Azelastine HCl Solution 0.05 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314030802",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.05 % OPHTHALMIC",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069009101",
      "ndc_label_name": "Azelastine HCl Solution 0.05 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332050606",
      "ndc_label_name": "Azelastine HCl Solution 0.05 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266014101",
      "ndc_label_name": "Azelastine HCl Solution 0.05 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335093890",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.05 % OPHTHALMIC",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205044930",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054029399",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335077991",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.1 % NASAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991081403",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162160103",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090253800",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291009430",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629205701",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090233000",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090527100",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505083305",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.1 % NASAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629251901",
      "ndc_label_name": "Azelastine HCl Solution 0.15 % Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383094230",
      "ndc_label_name": "Azelastine HCl Solution 0.15 % Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651021530",
      "ndc_label_name": "Azelastine HCl Solution 0.15 % Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505084805",
      "ndc_label_name": "Azelastine HCl Solution 0.15 % Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802002683",
      "ndc_label_name": "Azelastine HCl Solution 0.15 % Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382041506",
      "ndc_label_name": "Azelastine HCl Solution 137 MCG/SPRAY Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603061101",
      "ndc_label_name": "Azelastine HCl Solution 137 MCG/SPRAY Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788851402",
      "ndc_label_name": "Azelastine HCl Solution 137 MCG/SPRAY Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090746100",
      "ndc_label_name": "Azelastine HCl Solution 137 MCG/SPRAY Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877047750",
      "ndc_label_name": "Azelastine HCl SOLUTION 137 MCG/SPRAY Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651021430",
      "ndc_label_name": "Azelastine HCl Solution 137 MCG/SPRAY Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162067684",
      "ndc_label_name": "Azelastine HCl SOLUTION 137 MCG/SPRAY Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802006601",
      "ndc_label_name": "Azelastine-Fluticasone Suspension 137-50 MCG/ACT Nasal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378345823",
      "ndc_label_name": "Azelastine-Fluticasone Suspension 137-50 MCG/ACT Nasal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480215757",
      "ndc_label_name": "Azelastine-Fluticasone Suspension 137-50 MCG/ACT Nasal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162138802",
      "ndc_label_name": "Azelastine-Fluticasone Suspension 137-50 MCG/ACT Nasal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629861201",
      "ndc_label_name": "Azelastine-Fluticasone Suspension 137-50 MCG/ACT Nasal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162212702",
      "ndc_label_name": "Azelastine-Fluticasone Suspension 137-50 MCG/ACT Nasal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505095303",
      "ndc_label_name": "Azelastine-Fluticasone Suspension 137-50 MCG/ACT Nasal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68546014256",
      "ndc_label_name": "Azilect TABLET 0.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353001518",
      "ndc_label_name": "Azilect Tablet 1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68546022956",
      "ndc_label_name": "Azilect TABLET 1 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552130405",
      "ndc_label_name": "Azithromycin Dihydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991257701",
      "ndc_label_name": "Azithromycin Dihydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927417300",
      "ndc_label_name": "Azithromycin Dihydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991257703",
      "ndc_label_name": "Azithromycin Dihydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991257702",
      "ndc_label_name": "Azithromycin Dihydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552130406",
      "ndc_label_name": "Azithromycin Dihydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552130404",
      "ndc_label_name": "Azithromycin Dihydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991257704",
      "ndc_label_name": "Azithromycin Dihydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052023310",
      "ndc_label_name": "Azithromycin Dihydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762305102",
      "ndc_label_name": "Azithromycin Packet 1 GM Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762305101",
      "ndc_label_name": "Azithromycin Packet 1 GM Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762305105",
      "ndc_label_name": "Azithromycin Packet 1 GM Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000501",
      "ndc_label_name": "Azithromycin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779224605",
      "ndc_label_name": "Azithromycin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000505",
      "ndc_label_name": "Azithromycin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779224609",
      "ndc_label_name": "Azithromycin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779224604",
      "ndc_label_name": "Azithromycin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779224608",
      "ndc_label_name": "Azithromycin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000511",
      "ndc_label_name": "Azithromycin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000510",
      "ndc_label_name": "Azithromycin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592000525",
      "ndc_label_name": "Azithromycin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409014421",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323039801",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70095002501",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150017410",
      "ndc_label_name": "Azithromycin SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323039841",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021018010",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756051240",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409014411",
      "ndc_label_name": "Azithromycin SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021018066",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70095002502",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860012541",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860012566",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323039812",
      "ndc_label_name": "Azithromycin SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436001982",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323039814",
      "ndc_label_name": "Azithromycin SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756051244",
      "ndc_label_name": "Azithromycin SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860010041",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860010010",
      "ndc_label_name": "Azithromycin Solution Reconstituted 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323039810",
      "ndc_label_name": "Azithromycin SOLUTION RECONSTITUTED 500 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090186800",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43386047060",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 100 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093202723",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 100 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806014731",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651000715",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710145701",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090249100",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135070451",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762311001",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436022034",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788763601",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071152705",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 100 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788867501",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788822901",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806015134",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700073130",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093202623",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658070834",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806015033",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658070733",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090629600",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093202631",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090622600",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762314001",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806014932",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43386047161",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090098300",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090183500",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762312001",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093202694",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762313001",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788867603",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090098400",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788754903",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090626700",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672420003",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788822203",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658070632",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135070551",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710145802",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090445800",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090250900",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672420007",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135070543",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651000815",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672420005",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436022849",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187009322",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651000823",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959093230",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959093215",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071152805",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710145902",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919038230",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651000830",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436022134",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710146002",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788824601",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135070552",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436022236",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788826003",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205056615",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205021630",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904670806",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904670861",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527237032",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781808931",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781808926",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717506",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440717504",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527237020",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008230",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904735061",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904735006",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078710",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090321300",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353082206",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781577669",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571069581",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353069306",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008206",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571069503",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078766",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090460100",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436149601",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063072802",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090095800",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090338501",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063072804",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571069516",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436078701",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090472001",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762219807",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090338500",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090178800",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090460202",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353069387",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090472101",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224002218",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078751",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687028265",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090452700",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090460101",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090472102",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090178801",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268007413",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762219803",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224002230",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687074265",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090472000",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090643600",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090472103",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224002250",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762219801",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760050206",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919055506",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071039204",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090755000",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224002206",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268007415",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224002260",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687028211",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862064169",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332025118",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788765406",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436435701",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629267301",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436435601",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118078706",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760080806",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105067006",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187000704",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205002106",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959083806",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862064163",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002222404",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687074201",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105067005",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788880006",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862064130",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205015866",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700085906",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788870206",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002222806",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919036206",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094090006",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518256202",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105067018",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789017030",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687028201",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518078401",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700035106",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187016906",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086106",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008102",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094090030",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420000606",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332025130",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205043006",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700085206",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187060406",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518243301",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789048304",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094090050",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804021406",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187000706",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189008710",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687074211",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679096101",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518256201",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804018206",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788812406",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105067001",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094090018",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788810106",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919017006",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452017173",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518321700",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69677012906",
      "ndc_label_name": "Azithromycin TABLET 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518073600",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518080300",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016006",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205064506",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679096105",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610000106",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205015806",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008104",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518243300",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425021901",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016011",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105067003",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610000130",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518243302",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016013",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788706606",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425043101",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518243303",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086111",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452017113",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008008106",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205043004",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452017104",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518256200",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205011904",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610000187",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205042406",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518270800",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189009306",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610038106",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205042706",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420004606",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189008906",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420021306",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425021801",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781809003",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008330",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781809031",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527239519",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063071303",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527239532",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078867",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571069603",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904735104",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090193900",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904690904",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090096000",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063071379",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063071305",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687075311",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090193901",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063071302",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090452801",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008303",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090452800",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090165500",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063071307",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919077603",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090233500",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090729800",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090729900",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090233401",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078810",
      "ndc_label_name": "Azithromycin TABLET 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090165501",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090233400",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332025230",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090750600",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090729801",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959092703",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078855",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224012209",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090240700",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090413201",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105065303",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002004703",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54348085702",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094079909",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224012250",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224012230",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679096405",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090460600",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105065306",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687075321",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332025209",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189008803",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687027121",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687027111",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105065319",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090470000",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518059902",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788708205",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862064230",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789006679",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187018904",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094079903",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094079930",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090536600",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205049103",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788907803",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862064264",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789044579",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105065301",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788759803",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016111",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090536601",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016106",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518059901",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862064290",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090537600",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086206",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788877304",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016113",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268007611",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788708203",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518316802",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66105065305",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268007612",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788812503",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452017213",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452017272",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224012203",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518059900",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205019603",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788831103",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679096401",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518059905",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518309400",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452017274",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071077405",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518059906",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420058903",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788877303",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094079950",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189008802",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518325401",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518059903",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086211",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804015304",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425041201",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518316800",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518059904",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518316900",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189009002",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518316801",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518309401",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518325400",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789016930",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518325402",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205049104",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518325403",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789044507",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205051903",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050303",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205067403",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189001502",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789006302",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189009003",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789006607",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789006602",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789044502",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789006603",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425022001",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687031425",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111078910",
      "ndc_label_name": "Azithromycin TABLET 600 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224022230",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291004430",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781809131",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094069030",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687031495",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332025330",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291008430",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452017313",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442040330",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679096201",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518071300",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086306",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518324900",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180016206",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24338005501",
      "ndc_label_name": "Azmiro Solution Prefilled Syringe 200 MG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66758008570",
      "ndc_label_name": "Azopt Suspension 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065027515",
      "ndc_label_name": "Azopt Suspension 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66758008585",
      "ndc_label_name": "Azopt Suspension 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065027510",
      "ndc_label_name": "Azopt Suspension 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078072210",
      "ndc_label_name": "Azopt Suspension 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078072215",
      "ndc_label_name": "Azopt Suspension 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65597011130",
      "ndc_label_name": "Azor Tablet 10-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713087130",
      "ndc_label_name": "Azor Tablet 10-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65597011330",
      "ndc_label_name": "Azor Tablet 10-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713087330",
      "ndc_label_name": "Azor Tablet 10-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65597011030",
      "ndc_label_name": "Azor Tablet 5-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713087030",
      "ndc_label_name": "Azor Tablet 5-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65597011230",
      "ndc_label_name": "Azor Tablet 5-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713087230",
      "ndc_label_name": "Azor Tablet 5-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65038028699",
      "ndc_label_name": "Azstarys Capsule 26.1-5.2 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65038042999",
      "ndc_label_name": "Azstarys Capsule 39.2-7.8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65038056199",
      "ndc_label_name": "Azstarys Capsule 52.3-10.4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63323040126",
      "ndc_label_name": "Aztreonam Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040120",
      "ndc_label_name": "Aztreonam Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040101",
      "ndc_label_name": "Aztreonam Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409082901",
      "ndc_label_name": "Aztreonam Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040121",
      "ndc_label_name": "Aztreonam Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040141",
      "ndc_label_name": "Aztreonam Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040124",
      "ndc_label_name": "Aztreonam Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409082911",
      "ndc_label_name": "Aztreonam Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409083011",
      "ndc_label_name": "Aztreonam Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040220",
      "ndc_label_name": "Aztreonam Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409083001",
      "ndc_label_name": "Aztreonam Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040224",
      "ndc_label_name": "Aztreonam Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040201",
      "ndc_label_name": "Aztreonam Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040203",
      "ndc_label_name": "Aztreonam Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040241",
      "ndc_label_name": "Aztreonam Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040230",
      "ndc_label_name": "Aztreonam Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00013010201",
      "ndc_label_name": "Azulfidine EN-tabs Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00013010260",
      "ndc_label_name": "Azulfidine EN-tabs Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00013010250",
      "ndc_label_name": "Azulfidine EN-tabs Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00013010130",
      "ndc_label_name": "Azulfidine Tablet 500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00013010110",
      "ndc_label_name": "Azulfidine Tablet 500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00013010120",
      "ndc_label_name": "Azulfidine Tablet 500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862007201",
      "ndc_label_name": "Azurette Tablet 0.15-0.02/0.01 MG (21/5) Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907009128",
      "ndc_label_name": "Azurette Tablet 0.15-0.02/0.01 MG (21/5) Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862007206",
      "ndc_label_name": "Azurette Tablet 0.15-0.02/0.01 MG (21/5) Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862089001",
      "ndc_label_name": "Azurette Tablet 0.15-0.02/0.01 MG (21/5) Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907009162",
      "ndc_label_name": "Azurette Tablet 0.15-0.02/0.01 MG (21/5) Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862089006",
      "ndc_label_name": "Azurette Tablet 0.15-0.02/0.01 MG (21/5) Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72627242701",
      "ndc_label_name": "B-Complex Injectable Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72627242701",
      "ndc_label_name": "B-Complex Solution Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10267102701",
      "ndc_label_name": "B-Plex Plus Tablet Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10267102705",
      "ndc_label_name": "B-Plex Plus Tablet Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46672005350",
      "ndc_label_name": "BAC (Butalbital-Acetamin-Caff) Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "46672005310",
      "ndc_label_name": "BAC (Butalbital-Acetamin-Caff) Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "46672005310",
      "ndc_label_name": "Bac Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267095535",
      "ndc_label_name": "Bacitra-Neomycin-Polymyxin-HC Ointment 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208078555",
      "ndc_label_name": "Bacitra-Neomycin-Polymyxin-HC Ointment 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071935",
      "ndc_label_name": "Bacitra-Neomycin-Polymyxin-HC Ointment 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959023803",
      "ndc_label_name": "Bacitra-Neomycin-Polymyxin-HC Ointment 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999065335",
      "ndc_label_name": "Bacitra-Neomycin-Polymyxin-HC Ointment 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779001504",
      "ndc_label_name": "Bacitracin Micronized POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552131501",
      "ndc_label_name": "Bacitracin Micronized POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927166900",
      "ndc_label_name": "Bacitracin Micronized POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779001501",
      "ndc_label_name": "Bacitracin Micronized POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779001509",
      "ndc_label_name": "Bacitracin Micronized POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779001505",
      "ndc_label_name": "Bacitracin Micronized POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574402235",
      "ndc_label_name": "Bacitracin OINTMENT 500 UNIT/GM OPHTHALMIC",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991274401",
      "ndc_label_name": "Bacitracin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991274402",
      "ndc_label_name": "Bacitracin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594002601",
      "ndc_label_name": "Bacitracin Solution Reconstituted 50000 UNIT Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032931",
      "ndc_label_name": "Bacitracin Solution Reconstituted 50000 UNIT Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594002602",
      "ndc_label_name": "Bacitracin Solution Reconstituted 50000 UNIT Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572002501",
      "ndc_label_name": "Bacitracin Solution Reconstituted 50000 UNIT Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572002510",
      "ndc_label_name": "Bacitracin Solution Reconstituted 50000 UNIT Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927117600",
      "ndc_label_name": "Bacitracin Zinc POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090327400",
      "ndc_label_name": "Bacitracin-Polymyxin B Ointment 500-10000 UNIT/GM Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208055555",
      "ndc_label_name": "Bacitracin-Polymyxin B Ointment 500-10000 UNIT/GM Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267092535",
      "ndc_label_name": "Bacitracin-Polymyxin B Ointment 500-10000 UNIT/GM Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189001735",
      "ndc_label_name": "Bacitracin-Polymyxin B Ointment 500-10000 UNIT/GM Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788759903",
      "ndc_label_name": "Bacitracin-Polymyxin B Ointment 500-10000 UNIT/GM Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090718900",
      "ndc_label_name": "Bacitracin-Polymyxin B Ointment 500-10000 UNIT/GM Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81371600401",
      "ndc_label_name": "Baclofen (Bulk) Solution 500 MG/125ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552153307",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455072406",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144010210",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144010225",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779038806",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779038804",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779038808",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779038803",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60966022403",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144010201",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288121110",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552061307",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779287702",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779038805",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779038809",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779320903",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991101306",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592074311",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60966032402",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552153305",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779320904",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779287703",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779287706",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779320905",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998903",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60966012404",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991101301",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927200700",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50488100502",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779320909",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452080704",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779320908",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998905",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991101304",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68981000701",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592074322",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288121103",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144010205",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452080706",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452080702",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393020710",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991101305",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457994602",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592074325",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592074310",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452080701",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50488100500",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452080703",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68981000702",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307005027",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457994605",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60966042401",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393020705",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50488100501",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552061306",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452080705",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393020707",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307005049",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552153304",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991101303",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288121105",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552061302",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457994601",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552061304",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420016512",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457994604",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307005005",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552061305",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592074301",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552153302",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307005011",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288121102",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991101302",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592074305",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307005025",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998901",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307005015",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75840010401",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998902",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420016500",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68981000703",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998904",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457994603",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393020711",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457994606",
      "ndc_label_name": "Baclofen POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393020708",
      "ndc_label_name": "Baclofen Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789016101",
      "ndc_label_name": "Baclofen Refill Kit-SynchroMed Kit 40 MG/20ML Intrathecal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457056220",
      "ndc_label_name": "Baclofen Solution 10 MG/20ML Intrathecal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021067820",
      "ndc_label_name": "Baclofen Solution 10 MG/20ML Intrathecal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72834060216",
      "ndc_label_name": "Baclofen Solution 10 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817062008",
      "ndc_label_name": "Baclofen Solution 10 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888046602",
      "ndc_label_name": "Baclofen Solution 10 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68134040316",
      "ndc_label_name": "Baclofen Solution 10 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457056320",
      "ndc_label_name": "Baclofen Solution 20000 MCG/20ML Intrathecal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021068020",
      "ndc_label_name": "Baclofen Solution 20000 MCG/20ML Intrathecal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021067920",
      "ndc_label_name": "Baclofen Solution 40 MG/20ML Intrathecal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457056420",
      "ndc_label_name": "Baclofen Solution 40 MG/20ML Intrathecal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789016105",
      "ndc_label_name": "Baclofen Solution 40000 MCG/20ML Intrathecal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789016107",
      "ndc_label_name": "Baclofen Solution 40000 MCG/20ML Intrathecal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010324",
      "ndc_label_name": "Baclofen Solution 5 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817061916",
      "ndc_label_name": "Baclofen Solution 5 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68134040116",
      "ndc_label_name": "Baclofen Solution 5 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73352010316",
      "ndc_label_name": "Baclofen Solution 5 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021068171",
      "ndc_label_name": "Baclofen Solution Prefilled Syringe 50 MCG/ML Intrathecal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52536060012",
      "ndc_label_name": "Baclofen Suspension 25 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162234202",
      "ndc_label_name": "Baclofen Suspension 25 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71225014001",
      "ndc_label_name": "Baclofen Suspension 25 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52536060011",
      "ndc_label_name": "Baclofen Suspension 25 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559020403",
      "ndc_label_name": "Baclofen Suspension 25 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559020412",
      "ndc_label_name": "Baclofen Suspension 25 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162234204",
      "ndc_label_name": "Baclofen Suspension 25 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527133010",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00172409680",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135078101",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115101001",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603240621",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115101003",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571017150",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832105415",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603240628",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440718030",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090165001",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00172409660",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904647561",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527133001",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300034301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086430",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135078110",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832105410",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090165003",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722099810",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135053201",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603240632",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722099801",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090585501",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714007104",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832105411",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090249300",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090165000",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135053210",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571017101",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086460",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090614900",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086490",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904755261",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090614903",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090249303",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571017110",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714007106",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090686800",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010615",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090249301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300034310",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090686900",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090686803",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090614901",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999060745",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090686801",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436902201",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090760000",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291015810",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090760003",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436902205",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090760100",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090585503",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436902203",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817032010",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436006001",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090585500",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073302",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407097310",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700040301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289075730",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817032000",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073300",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436902202",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090760001",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073312",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817032050",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039401",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700097401",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073318",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073390",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700040390",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010611",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073320",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073310",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919002630",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700097430",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073330",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657073101",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700097460",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407097301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657073110",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289075760",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009372",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700097490",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073340",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687050301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135047390",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154763500",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009307",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700040360",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135047305",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657093101",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959073360",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687081511",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187014730",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289075790",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187014720",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039499",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629122501",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039405",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700040330",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919002660",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187031330",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919002690",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629122401",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629128608",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629128604",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187014790",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657093105",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009314",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629212901",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187031372",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629128606",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629208001",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084085511",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187031320",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687050311",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009330",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739023001",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187031378",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629128607",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739047910",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788764303",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187031360",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687081501",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009360",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544067160",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187031390",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629128609",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788764309",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788764306",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544067192",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687081565",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009390",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544067180",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629128603",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788764308",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788857208",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788858403",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084085501",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009386",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187014760",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788855509",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629128605",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788857206",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788878306",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788872608",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788818101",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187014778",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629208201",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710128500",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788764301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788857209",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788878309",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518308900",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788818106",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788818108",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629212801",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020602",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788818103",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788878303",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788924601",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205047414",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788855501",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518361401",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788818109",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020605",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788855508",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788878308",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710128501",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205047472",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788858406",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020608",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788855503",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335034404",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788857203",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518036200",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205047420",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335034406",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788858409",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335034401",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788855506",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335034407",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788878301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518036201",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020600",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335034409",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788872603",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335034408",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788857201",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335164307",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788924603",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518280400",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020603",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335239204",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788872606",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335164302",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788858401",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335179702",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788924608",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756028811",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020606",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335963807",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788872609",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335164303",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788858408",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335963801",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788924609",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756028812",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020609",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610066060",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512078210",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335179703",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788872601",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610045292",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518280401",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205047430",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335034400",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610092480",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020604",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610066092",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788924606",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162107900",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205047478",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205047460",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335034403",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930000613",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020607",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610092453",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710128505",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162107909",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205047490",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335179707",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335164301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162244900",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335034402",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789050830",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610045260",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162237300",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335020601",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162107901",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335282601",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789047995",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335034405",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73320000202",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610045280",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162237301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335975902",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888001000",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335963802",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420024130",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335179701",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73320000204",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420024160",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789050890",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335975907",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888001001",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335963804",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425039101",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335179704",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425015601",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425039103",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425015602",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610092460",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420024190",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335975904",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008001530",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335239201",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425039102",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425056803",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425015604",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610092492",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425056802",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610066080",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804024260",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335239202",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425039104",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804024272",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804024278",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162115201",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804024230",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425015603",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008005760",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335239207",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008001590",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789047901",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008005790",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335975901",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888001005",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930000612",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425008002",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162107908",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425008003",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162244901",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425056801",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73320000203",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425056804",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804024290",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008001560",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008005730",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710166601",
      "ndc_label_name": "Baclofen Tablet 15 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817031810",
      "ndc_label_name": "Baclofen Tablet 15 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00172409760",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115101203",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527133701",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115101201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440718130",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300034401",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904755361",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527133705",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00172409780",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135078201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527133710",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603240721",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603240728",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722099905",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135078210",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603240732",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300034410",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090468202",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832105515",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135053310",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904647661",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436902301",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714007204",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832105511",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086560",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010711",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135053301",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571017250",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135053305",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407097410",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090180102",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135078205",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436902302",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135047490",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571017210",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090180101",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571017201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067790",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090468201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086530",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817032150",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739048010",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722099901",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090583802",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714007205",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657093201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090583803",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063086590",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700040860",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084086801",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722099910",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067710",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090583801",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039599",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010715",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090468203",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009582",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788756203",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407097401",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039501",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817032100",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788638403",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067730",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436902303",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187027430",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788756206",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067702",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687082601",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817032110",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788756209",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067745",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067760",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739023301",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788763503",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700040830",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919002730",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039505",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788873703",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657073201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700040890",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788638401",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788763508",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657093205",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009560",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687051401",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788873706",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009586",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657073210",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788763506",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833303",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629122801",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135047405",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687051411",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788873708",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187028030",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629208301",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833301",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833309",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629213101",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629122601",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687082611",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710128605",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267087291",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629208401",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788873701",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788857503",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788638408",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788638406",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009530",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756028911",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084086811",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629213001",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335275601",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335010301",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788873709",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788756208",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009590",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335266903",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788763501",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267087260",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335275602",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335179601",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756028951",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833306",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629122701",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335275603",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788791501",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788791508",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610039192",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335221903",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335094900",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788857508",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788638409",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335275606",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788791503",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788791509",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610044492",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335266902",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335221901",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518217300",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788756201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189056582",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788833308",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788857506",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610061445",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162237406",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335249701",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710128600",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788763509",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73320000303",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788857501",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788857509",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610061492",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162245000",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610039160",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710128601",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788791506",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425020501",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518266200",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756028912",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162108006",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162245002",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789031230",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335010306",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518266201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425020503",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335010300",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610044645",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162108009",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789031290",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789048001",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335179603",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518311500",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789048090",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335010303",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610044660",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162237400",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028204",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888001100",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610044460",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518311501",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425045903",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335166401",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610092192",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162237401",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425045904",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73320000304",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189050490",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335266901",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425046701",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610044692",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162108001",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189050430",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425046702",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420024290",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888001101",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610039145",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008001860",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610061460",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425047801",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189050460",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008001890",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425015702",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028202",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610044445",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008006230",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610092160",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425047802",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189056560",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008006260",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425020502",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930000712",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930000713",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189056590",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162108000",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420024260",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162108003",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789048095",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162108005",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028203",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162237402",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420024230",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162245001",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425045901",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189050482",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425011201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888001105",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425045902",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73320000302",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425011202",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425008102",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425047803",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425046603",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425015701",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425046703",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008001830",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425046704",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425047804",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425046601",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425046602",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425046604",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008006290",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "85509134403",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "85509134406",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "85509134409",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115101101",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687080465",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135047290",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571016901",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135078001",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010515",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527133301",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300047401",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817031910",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687080411",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789047801",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407097201",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722013801",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888000901",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010511",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930006612",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710160901",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657093001",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73320000102",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756008511",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657073001",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162237201",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657093005",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789047830",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162244801",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927950700",
      "ndc_label_name": "Bacocalmine Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552066209",
      "ndc_label_name": "Bacon Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991261901",
      "ndc_label_name": "Bacon Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927367600",
      "ndc_label_name": "Bacon Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991261902",
      "ndc_label_name": "Bacon Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00409397703",
      "ndc_label_name": "Bacteriostatic Water(Benz Alc) SOLUTION INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518123601",
      "ndc_label_name": "Bacteriostatic Water(Benz Alc) Solution Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409397701",
      "ndc_label_name": "Bacteriostatic Water(Benz Alc) SOLUTION INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72627260004",
      "ndc_label_name": "Bacteriostatic Water(Benz Alc) Solution Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72627260005",
      "ndc_label_name": "Bacteriostatic Water(Benz Alc) Solution Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518123600",
      "ndc_label_name": "Bacteriostatic Water(Benz Alc) Solution Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81483003400",
      "ndc_label_name": "Bacteriostatic Water(Benz Alc) Solution Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49708014601",
      "ndc_label_name": "Bactrim DS Tablet 800-160 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999064910",
      "ndc_label_name": "Bactrim DS Tablet 800-160 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999064960",
      "ndc_label_name": "Bactrim DS Tablet 800-160 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999064920",
      "ndc_label_name": "Bactrim DS Tablet 800-160 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999064930",
      "ndc_label_name": "Bactrim DS Tablet 800-160 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999064990",
      "ndc_label_name": "Bactrim DS Tablet 800-160 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999023220",
      "ndc_label_name": "Bactrim Tablet 400-80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49708014501",
      "ndc_label_name": "Bactrim Tablet 400-80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69387000101",
      "ndc_label_name": "Bafiertam Capsule Delayed Release 95 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478052603",
      "ndc_label_name": "Bal in Oil Solution 100 MG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75854060203",
      "ndc_label_name": "Balcoltra Tablet 0.1-20 MG-MCG(21) Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75854060202",
      "ndc_label_name": "Balcoltra Tablet 0.1-20 MG-MCG(21) Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75854060228",
      "ndc_label_name": "Balcoltra Tablet 0.1-20 MG-MCG(21) Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407082028",
      "ndc_label_name": "Balsalazide Disodium Capsule 750 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014969",
      "ndc_label_name": "Balsalazide Disodium Capsule 750 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291015728",
      "ndc_label_name": "Balsalazide Disodium Capsule 750 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010211",
      "ndc_label_name": "Balsalazide Disodium CAPSULE 750 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010213",
      "ndc_label_name": "Balsalazide Disodium CAPSULE 750 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054007928",
      "ndc_label_name": "Balsalazide Disodium CAPSULE 750 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162209502",
      "ndc_label_name": "Balsalazide Disodium Capsule 750 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710162601",
      "ndc_label_name": "Balsalazide Disodium Capsule 750 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505257507",
      "ndc_label_name": "Balsalazide Disodium CAPSULE 750 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80005012625",
      "ndc_label_name": "Balsalazide Disodium Capsule 750 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59676003056",
      "ndc_label_name": "Balversa Tablet 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59676003084",
      "ndc_label_name": "Balversa Tablet 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59676004056",
      "ndc_label_name": "Balversa Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59676004028",
      "ndc_label_name": "Balversa Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59676005028",
      "ndc_label_name": "Balversa Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555903458",
      "ndc_label_name": "Balziva TABLET 0.4-35 MG-MCG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555903479",
      "ndc_label_name": "Balziva TABLET 0.4-35 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840570205",
      "ndc_label_name": "Banana (Diagnostic) Solution 1:40 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927203900",
      "ndc_label_name": "Banana Concentrate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552016803",
      "ndc_label_name": "Banana Concentrate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779101608",
      "ndc_label_name": "Banana Cream Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779101605",
      "ndc_label_name": "Banana Cream Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991153801",
      "ndc_label_name": "Banana Cream Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991153802",
      "ndc_label_name": "Banana Cream Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991153804",
      "ndc_label_name": "Banana Cream Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779101604",
      "ndc_label_name": "Banana Cream Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927216900",
      "ndc_label_name": "Banana Creme Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452081202",
      "ndc_label_name": "Banana Creme Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452081203",
      "ndc_label_name": "Banana Creme Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452081204",
      "ndc_label_name": "Banana Creme Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86067000001",
      "ndc_label_name": "Banana Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779225308",
      "ndc_label_name": "Banana Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779297702",
      "ndc_label_name": "Banana Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779297701",
      "ndc_label_name": "Banana Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62856058446",
      "ndc_label_name": "Banzel Suspension 40 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62856058252",
      "ndc_label_name": "Banzel Tablet 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62856058352",
      "ndc_label_name": "Banzel Tablet 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00548835101",
      "ndc_label_name": "Baqsimi One Pack Powder 3 MG/DOSE Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002614511",
      "ndc_label_name": "Baqsimi One Pack Powder 3 MG/DOSE Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002614527",
      "ndc_label_name": "Baqsimi Two Pack Powder 3 MG/DOSE Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00548835202",
      "ndc_label_name": "Baqsimi Two Pack Powder 3 MG/DOSE Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003161412",
      "ndc_label_name": "Baraclude SOLUTION 0.05 MG/ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003161112",
      "ndc_label_name": "Baraclude TABLET 0.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003161212",
      "ndc_label_name": "Baraclude TABLET 1 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08011750379",
      "ndc_label_name": "Bard Piston Ent Irrigation Syr",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002771501",
      "ndc_label_name": "Basaglar KwikPen Solution Pen-injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002771559",
      "ndc_label_name": "Basaglar KwikPen Solution Pen-injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002821405",
      "ndc_label_name": "Basaglar Tempo Pen Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002821401",
      "ndc_label_name": "Basaglar Tempo Pen Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592061511",
      "ndc_label_name": "Base A Polyethylene Glycol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927901300",
      "ndc_label_name": "Base A Polyethylene Glycol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592061510",
      "ndc_label_name": "Base A Polyethylene Glycol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457991101",
      "ndc_label_name": "Base A Polyethylene Glycol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592061550",
      "ndc_label_name": "Base A Polyethylene Glycol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457991102",
      "ndc_label_name": "Base A Polyethylene Glycol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592061505",
      "ndc_label_name": "Base A Polyethylene Glycol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592061545",
      "ndc_label_name": "Base A Polyethylene Glycol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592061743",
      "ndc_label_name": "Base C Polyethylene Glycol 300 Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927901200",
      "ndc_label_name": "Base C Polyethylene Glycol 300 Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592061770",
      "ndc_label_name": "Base C Polyethylene Glycol 300 Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592061732",
      "ndc_label_name": "Base C Polyethylene Glycol 300 Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927514000",
      "ndc_label_name": "Base D Polyethyl Glycol 4600 Granules",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927901500",
      "ndc_label_name": "Base D Polyethylene Glycol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592003332",
      "ndc_label_name": "Base G Almond Oil (Sweet) Oil",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592003370",
      "ndc_label_name": "Base G Almond Oil (Sweet) Oil",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592003343",
      "ndc_label_name": "Base G Almond Oil (Sweet) Oil",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927902700",
      "ndc_label_name": "Base G Almond Oil (Sweet) OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991279301",
      "ndc_label_name": "Base Gelatin Gummy Troche GEL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927111600",
      "ndc_label_name": "Base X FLAKES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452085001",
      "ndc_label_name": "Basic Fuchsin HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927131900",
      "ndc_label_name": "Basic Fuchsin HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70842010203",
      "ndc_label_name": "Baxdela SOLUTION RECONSTITUTED 300 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70842010103",
      "ndc_label_name": "Baxdela Tablet 450 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70842010102",
      "ndc_label_name": "Baxdela Tablet 450 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70842010101",
      "ndc_label_name": "Baxdela TABLET 450 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452087501",
      "ndc_label_name": "Bay Oil Oil",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452087502",
      "ndc_label_name": "Bay Oil Oil",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452087503",
      "ndc_label_name": "Bay Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290305181",
      "ndc_label_name": "BD Blunt Fill Needle 18G X 1\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290841002",
      "ndc_label_name": "BD Insulin Syringe MicroFine 28G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290329410",
      "ndc_label_name": "BD Insulin Syringe MicroFine 28G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290329420",
      "ndc_label_name": "BD Insulin Syringe MicroFine 28G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290329424",
      "ndc_label_name": "BD Insulin Syringe MicroFine 28G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090646100",
      "ndc_label_name": "BD Insulin Syringe MicroFine 28G X 1/2\" 1 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290326730",
      "ndc_label_name": "BD Insulin Syringe U-500 31G X 6MM 0.5 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290366594",
      "ndc_label_name": "BD Microtainer Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290366592",
      "ndc_label_name": "BD Microtainer Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08290366593",
      "ndc_label_name": "BD Microtainer Lancets",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08290328449",
      "ndc_label_name": "BD SafetyGlide Insulin Syringe 31G X 15/64\" 0.3 ML",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290301625",
      "ndc_label_name": "BD Syringe Luer Slip Tip 20 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290302831",
      "ndc_label_name": "BD Syringe Luer Slip Tip 20 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290309702",
      "ndc_label_name": "BD Syringe Luer-Lok 3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290309646",
      "ndc_label_name": "BD Syringe Luer-Lok 5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08290309703",
      "ndc_label_name": "BD Syringe Luer-Lok 5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290309656",
      "ndc_label_name": "BD Syringe Slip Tip 3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290256040",
      "ndc_label_name": "BD Veritor System Group A Strp Kit In Vitro",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779036406",
      "ndc_label_name": "Beclomethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779036403",
      "ndc_label_name": "Beclomethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452080201",
      "ndc_label_name": "Beclomethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452080202",
      "ndc_label_name": "Beclomethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779036401",
      "ndc_label_name": "Beclomethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452080203",
      "ndc_label_name": "Beclomethasone Dipropionate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927164100",
      "ndc_label_name": "Beclomethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552088309",
      "ndc_label_name": "Beclomethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552088302",
      "ndc_label_name": "Beclomethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452080205",
      "ndc_label_name": "Beclomethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102001",
      "ndc_label_name": "Beclomethasone Dipropionate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452080204",
      "ndc_label_name": "Beclomethasone Dipropionate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102002",
      "ndc_label_name": "Beclomethasone Dipropionate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552088301",
      "ndc_label_name": "Beclomethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102004",
      "ndc_label_name": "Beclomethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102005",
      "ndc_label_name": "Beclomethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840575705",
      "ndc_label_name": "Beef (Diagnostic) Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927478600",
      "ndc_label_name": "Beef (Grilled) Flavor Oil Sol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452088203",
      "ndc_label_name": "Beef Braised Natural Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452088201",
      "ndc_label_name": "Beef Braised Natural Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452088202",
      "ndc_label_name": "Beef Braised Natural Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552063409",
      "ndc_label_name": "Beef Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927289700",
      "ndc_label_name": "Beef Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927386600",
      "ndc_label_name": "Beef Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779194204",
      "ndc_label_name": "Beef Flavor POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779194208",
      "ndc_label_name": "Beef Flavor POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779194205",
      "ndc_label_name": "Beef Flavor POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991263902",
      "ndc_label_name": "Beef Type Flavor Natural Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991283101",
      "ndc_label_name": "Beef Type Flavor Natural Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991283102",
      "ndc_label_name": "Beef Type Flavor Natural Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991263901",
      "ndc_label_name": "Beef Type Flavor Natural Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991315801",
      "ndc_label_name": "Beef Type Flavor OS Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991315802",
      "ndc_label_name": "Beef Type Flavor OS Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927378800",
      "ndc_label_name": "Beef-Ade POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779183408",
      "ndc_label_name": "Bees Wax WAX",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779183405",
      "ndc_label_name": "Bees Wax WAX",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779183409",
      "ndc_label_name": "Bees Wax WAX",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927243400",
      "ndc_label_name": "Beeswax (Yellow) WAX",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927114300",
      "ndc_label_name": "Beeswax WAX",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552116206",
      "ndc_label_name": "Beeswax WAX",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59385002201",
      "ndc_label_name": "Belbuca Film 150 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59385002260",
      "ndc_label_name": "Belbuca Film 150 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59385002301",
      "ndc_label_name": "Belbuca Film 300 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59385002360",
      "ndc_label_name": "Belbuca Film 300 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59385002401",
      "ndc_label_name": "Belbuca Film 450 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59385002460",
      "ndc_label_name": "Belbuca Film 450 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59385002501",
      "ndc_label_name": "Belbuca Film 600 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59385002560",
      "ndc_label_name": "Belbuca Film 600 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59385002101",
      "ndc_label_name": "Belbuca Film 75 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59385002160",
      "ndc_label_name": "Belbuca Film 75 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59385002601",
      "ndc_label_name": "Belbuca Film 750 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59385002660",
      "ndc_label_name": "Belbuca Film 750 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59385002701",
      "ndc_label_name": "Belbuca Film 900 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59385002760",
      "ndc_label_name": "Belbuca Film 900 MCG Buccal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51927112000",
      "ndc_label_name": "Belladonna Extract POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927182300",
      "ndc_label_name": "Belladonna TINCTURE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779102208",
      "ndc_label_name": "Belladonna TINCTURE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006003330",
      "ndc_label_name": "Belsomra TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006003310",
      "ndc_label_name": "Belsomra TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006032530",
      "ndc_label_name": "Belsomra TABLET 15 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006032510",
      "ndc_label_name": "Belsomra TABLET 15 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006033510",
      "ndc_label_name": "Belsomra TABLET 20 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006033530",
      "ndc_label_name": "Belsomra TABLET 20 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006000510",
      "ndc_label_name": "Belsomra TABLET 5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006000530",
      "ndc_label_name": "Belsomra TABLET 5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927202300",
      "ndc_label_name": "Benactyzine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052017305",
      "ndc_label_name": "Benazepril HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927431900",
      "ndc_label_name": "Benazepril HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052017302",
      "ndc_label_name": "Benazepril HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052017310",
      "ndc_label_name": "Benazepril HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155075005",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155075001",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781189201",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719090",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547033650",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291016101",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719030",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011015",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959084130",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090377502",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063067990",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291016150",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090091200",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063067930",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959084160",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162075250",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118033809",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090575100",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090377500",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547033610",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304033801",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090091202",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518025201",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189011030",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788887709",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407046305",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090575102",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011011",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335085404",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304033805",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189011090",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118033808",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162181603",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746075205",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407046301",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919028030",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746075201",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788887701",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162075210",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518025200",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862011601",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760035190",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788887706",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788887703",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335085401",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919028060",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162181609",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135072090",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518307400",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155075101",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547033710",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719290",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719230",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063067730",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324301",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291016201",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155075105",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090091301",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999075930",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090091300",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291016250",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090575001",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011111",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547033703",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187039330",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324300",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959083130",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118033909",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063067790",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407046401",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746075305",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090575000",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862011701",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919073990",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54458086316",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162075350",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547033750",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700029190",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304033905",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011115",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407046405",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304033901",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760035290",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934060890",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746075301",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187039390",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518164000",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118033908",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162075310",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518164001",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135072190",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071014660",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934022890",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071014690",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071014630",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518317200",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934060830",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071014691",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719390",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155075201",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291016350",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090335900",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155075205",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719330",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291016301",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063074830",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959083530",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090091400",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011215",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118034009",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547033810",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090091401",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547033803",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746075401",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746075405",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135072290",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407046505",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187090630",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407046501",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862011801",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547033850",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162075450",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54458086216",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187090690",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518212501",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304034005",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118034003",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071002690",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090335901",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071002660",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071002630",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788784503",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518317100",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788695709",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919075690",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788784508",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011211",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788695703",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788695701",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788784509",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959083560",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934054530",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518212500",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788695706",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304034001",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788784501",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162075410",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788784506",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788695708",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205032030",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010911",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547033510",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118033703",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010915",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155074901",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155074905",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407046201",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781189101",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291016001",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407046205",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629267901",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135071990",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746075105",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356058760",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162075150",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356058730",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291016050",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356058790",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746075101",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118033709",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304033701",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162075110",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185032501",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 10-12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980019401",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462057701",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574022701",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888022001",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559041501",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574022901",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559041601",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185021101",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 20-12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462057801",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629268003",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888022101",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629268001",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980019501",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629268002",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162232801",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980019601",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574022801",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462057901",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185027701",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959090730",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559041701",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888022201",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185023601",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559041401",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462057601",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58394063503",
      "ndc_label_name": "BeneFIX KIT 1000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58394063603",
      "ndc_label_name": "BeneFIX KIT 2000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58394063303",
      "ndc_label_name": "BeneFIX KIT 250 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58394063703",
      "ndc_label_name": "BeneFIX KIT 3000 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58394063403",
      "ndc_label_name": "BeneFIX KIT 500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927481600",
      "ndc_label_name": "Benfotiamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713086330",
      "ndc_label_name": "Benicar HCT Tablet 20-12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65597010530",
      "ndc_label_name": "Benicar HCT Tablet 20-12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090108300",
      "ndc_label_name": "Benicar HCT Tablet 40-12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713086430",
      "ndc_label_name": "Benicar HCT Tablet 40-12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356028840",
      "ndc_label_name": "Benicar HCT Tablet 40-12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65597010630",
      "ndc_label_name": "Benicar HCT Tablet 40-12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713086530",
      "ndc_label_name": "Benicar HCT Tablet 40-25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65597010730",
      "ndc_label_name": "Benicar HCT Tablet 40-25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356025890",
      "ndc_label_name": "Benicar HCT Tablet 40-25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356028940",
      "ndc_label_name": "Benicar HCT Tablet 40-25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090087700",
      "ndc_label_name": "Benicar Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713086130",
      "ndc_label_name": "Benicar Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65597010330",
      "ndc_label_name": "Benicar Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713094130",
      "ndc_label_name": "Benicar Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713094230",
      "ndc_label_name": "Benicar Tablet 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65597010430",
      "ndc_label_name": "Benicar Tablet 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713086230",
      "ndc_label_name": "Benicar Tablet 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65597010130",
      "ndc_label_name": "Benicar Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713086030",
      "ndc_label_name": "Benicar Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356028720",
      "ndc_label_name": "Benicar Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356028730",
      "ndc_label_name": "Benicar Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49401008801",
      "ndc_label_name": "Benlysta Solution Auto-injector 200 MG/ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49401008835",
      "ndc_label_name": "Benlysta Solution Auto-injector 200 MG/ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49401008802",
      "ndc_label_name": "Benlysta Solution Auto-injector 200 MG/ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49401008861",
      "ndc_label_name": "Benlysta Solution Auto-Injector 200 MG/ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49401008842",
      "ndc_label_name": "Benlysta Solution Prefilled Syringe 200 MG/ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49401008847",
      "ndc_label_name": "Benlysta Solution Prefilled Syringe 200 MG/ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452092003",
      "ndc_label_name": "Bentonite POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452092002",
      "ndc_label_name": "Bentonite POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552013506",
      "ndc_label_name": "Bentonite POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452092001",
      "ndc_label_name": "Bentonite POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927119500",
      "ndc_label_name": "Bentonite POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58914008052",
      "ndc_label_name": "Bentyl Solution 10 MG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090455300",
      "ndc_label_name": "Bentyl Solution 10 MG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00299364008",
      "ndc_label_name": "Benzac AC Wash Liquid 5 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452093002",
      "ndc_label_name": "Benzaldehyde ELIXIR ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452093001",
      "ndc_label_name": "Benzaldehyde ELIXIR ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452093003",
      "ndc_label_name": "Benzaldehyde ELIXIR ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "42546001718",
      "ndc_label_name": "BenzePrO Creamy Wash Liquid 7 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42546000260",
      "ndc_label_name": "BenzePrO Foam 9.7 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42546000505",
      "ndc_label_name": "BenzePrO Liquid 6.8 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452096003",
      "ndc_label_name": "Benzethonium Chloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452096002",
      "ndc_label_name": "Benzethonium Chloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452096001",
      "ndc_label_name": "Benzethonium Chloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452096005",
      "ndc_label_name": "Benzethonium Chloride Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452096004",
      "ndc_label_name": "Benzethonium Chloride Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927297800",
      "ndc_label_name": "Benzethonium Chloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10702034301",
      "ndc_label_name": "Benzhydrocodone-Acetaminophen Tablet 4.08-325 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702034401",
      "ndc_label_name": "Benzhydrocodone-Acetaminophen Tablet 6.12-325 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702034501",
      "ndc_label_name": "Benzhydrocodone-Acetaminophen Tablet 8.16-325 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00642746410",
      "ndc_label_name": "Benznidazole TABLET 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00642746312",
      "ndc_label_name": "Benznidazole TABLET 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592004001",
      "ndc_label_name": "Benzocaine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779006303",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779006309",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779006305",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779006304",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592004025",
      "ndc_label_name": "Benzocaine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779006307",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452097004",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60592004050",
      "ndc_label_name": "Benzocaine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779006308",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452097001",
      "ndc_label_name": "Benzocaine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452097003",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552013007",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457993401",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552013002",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552013006",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592004010",
      "ndc_label_name": "Benzocaine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144044401",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452097002",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552013004",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592004061",
      "ndc_label_name": "Benzocaine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457993403",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927119400",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592004011",
      "ndc_label_name": "Benzocaine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102105",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102106",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052067310",
      "ndc_label_name": "Benzocaine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592004005",
      "ndc_label_name": "Benzocaine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052067305",
      "ndc_label_name": "Benzocaine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998602",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102102",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102104",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998604",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998601",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998605",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457993402",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102108",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457993404",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052067350",
      "ndc_label_name": "Benzocaine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998603",
      "ndc_label_name": "Benzocaine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452098001",
      "ndc_label_name": "Benzoic Acid CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452098002",
      "ndc_label_name": "Benzoic Acid CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552022505",
      "ndc_label_name": "Benzoic Acid CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452098003",
      "ndc_label_name": "Benzoic Acid CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552022504",
      "ndc_label_name": "Benzoic Acid CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927111400",
      "ndc_label_name": "Benzoic Acid CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779061505",
      "ndc_label_name": "Benzoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779061501",
      "ndc_label_name": "Benzoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779061508",
      "ndc_label_name": "Benzoic Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927205400",
      "ndc_label_name": "Benzoin Gum POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806071401",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722095601",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904656461",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440718585",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42192061705",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904656460",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722095605",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291009101",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063079812",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291009150",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904715361",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788002805",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063079806",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788002801",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42192061701",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063079820",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063098001",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063098130",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806071405",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155089805",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063079815",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155089801",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063079830",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063098110",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090496902",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429092701",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063079810",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063091015",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063079821",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063079801",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063098121",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063098112",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959041110",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919032520",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429092730",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090322805",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090322802",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063098030",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063098124",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063098115",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959041115",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332042671",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760070015",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090540905",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090620505",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063098082",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090321200",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999029750",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700055620",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187001620",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760086930",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224001050",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090638705",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063098106",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090540902",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090322800",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762112201",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629244301",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919057330",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002058915",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959041120",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063098120",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090622800",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090322801",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429092705",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267003321",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187079940",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760070030",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959041130",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090598600",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090685000",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090540900",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919003115",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788760701",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187092810",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919057320",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919003120",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090620500",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002058910",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090540901",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187001630",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518287300",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187092821",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135044001",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919003130",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090620501",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002058920",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090620502",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187007614",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205063230",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187092830",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629247401",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919032530",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090638700",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002058930",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090638701",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084021411",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205066230",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980063450",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980063401",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187092840",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436599502",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760057330",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090638702",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382024701",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085300",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877057301",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788760703",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380071206",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224001060",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919057315",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760086915",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788760704",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205097115",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788760700",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610069260",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267076504",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700055630",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135044090",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629918901",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934012120",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205097130",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452014320",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162156105",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382024705",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700092230",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187001640",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877057305",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085355",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919040030",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934012115",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789023012",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788760709",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135044031",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187092814",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788760705",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205088500",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332042631",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205006740",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518287301",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452014330",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187092820",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380071207",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934012109",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205088520",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629247301",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205063221",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934067520",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518093001",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739002910",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788760702",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205063220",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205088521",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084021401",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205088515",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085321",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518287302",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788635705",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085314",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205088555",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162156101",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005830",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205088530",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610069230",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518287303",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934012130",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085315",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789023030",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162191305",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205006710",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610069253",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205006715",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934067530",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205006720",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205097155",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205006730",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189019430",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205069921",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789023015",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085330",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205069930",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205088514",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71626020101",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335068801",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789023021",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789001415",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789023115",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085310",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789023020",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865011730",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008002330",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205085320",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205088510",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205097100",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205097110",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205097114",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205097120",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205097121",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335267201",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789023006",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865011701",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927367200",
      "ndc_label_name": "Benzoquinone (Para) CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284602",
      "ndc_label_name": "Benzoyl Peroxide Hydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452101001",
      "ndc_label_name": "Benzoyl Peroxide Hydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284603",
      "ndc_label_name": "Benzoyl Peroxide Hydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452101004",
      "ndc_label_name": "Benzoyl Peroxide Hydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452101002",
      "ndc_label_name": "Benzoyl Peroxide Hydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452101006",
      "ndc_label_name": "Benzoyl Peroxide Hydrous Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452101003",
      "ndc_label_name": "Benzoyl Peroxide Hydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452101005",
      "ndc_label_name": "Benzoyl Peroxide Hydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452101007",
      "ndc_label_name": "Benzoyl Peroxide Hydrous Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284601",
      "ndc_label_name": "Benzoyl Peroxide Hydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284605",
      "ndc_label_name": "Benzoyl Peroxide Hydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284604",
      "ndc_label_name": "Benzoyl Peroxide Hydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927308500",
      "ndc_label_name": "Benzoyl Peroxide POWDER 70 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143972905",
      "ndc_label_name": "Benztropine Mesylate SOLUTION 1 MG/ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143923305",
      "ndc_label_name": "Benztropine Mesylate Solution 1 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382086002",
      "ndc_label_name": "Benztropine Mesylate Solution 1 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143923301",
      "ndc_label_name": "Benztropine Mesylate Solution 1 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382086010",
      "ndc_label_name": "Benztropine Mesylate Solution 1 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143972901",
      "ndc_label_name": "Benztropine Mesylate Solution 1 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323097002",
      "ndc_label_name": "Benztropine Mesylate SOLUTION 1 MG/ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243721",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904728861",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243321",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135060610",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135081301",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904678861",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135060601",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243332",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243732",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228022501",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11534016710",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135081310",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518169101",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11534016709",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353091309",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629213301",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353070709",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135014157",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687035601",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518169103",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518169102",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629960501",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135014118",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315013601",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228022510",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518169104",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687035611",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518072000",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518273201",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518072001",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629213201",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518168800",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64125013601",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162259400",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097082607",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518168801",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70752012310",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518273202",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315013610",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64125013610",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518072002",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162259401",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70752012311",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084038101",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385010310",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162259402",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084038111",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385010301",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518273200",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162115501",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243832",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719530",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719592",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719560",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243432",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243421",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243821",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135060701",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353058030",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11534016809",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904728961",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719590",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353079630",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904679061",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135060710",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228022601",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090311600",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11534016810",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090602200",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64125013710",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135014401",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135081410",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135081401",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135014418",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385010401",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687036801",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228022610",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518057704",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097082707",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353058053",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353079653",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097082715",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518057700",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687036811",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135014457",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518057800",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518144701",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518057702",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090701700",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315013701",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70752012410",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135014410",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187084003",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518144702",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162259502",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518057703",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64125013701",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162259501",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518088100",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610050253",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084038801",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518144703",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162259500",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084038811",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385010410",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315013710",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518057701",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518144704",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70752012411",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719660",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243921",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243932",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243532",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904729061",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719630",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719690",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135060801",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440719692",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11534016909",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135081501",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11534016910",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135081510",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603243521",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904678961",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135014257",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090269500",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919012830",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135014210",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228022701",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135014218",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228022710",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135060810",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518267700",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64125013801",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135014201",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64125013810",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629213501",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629942201",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687037901",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687037911",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385010510",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084038901",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315013801",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629213401",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315013810",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162259602",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084038911",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097083207",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70752012511",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385010501",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162259600",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097083215",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162259601",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518267701",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70752012510",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927496100",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452102003",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452102002",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60592001032",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779102908",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452102001",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779102901",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991131802",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60592001043",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552024205",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552024207",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927139100",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592001070",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991131801",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452102503",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592003233",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552085905",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991164506",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60592003232",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452102502",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779103009",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779103001",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991164502",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60592003243",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991164504",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779103007",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452102501",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927142200",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991164505",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779103008",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592003270",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552085907",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "24208063005",
      "ndc_label_name": "Bepotastine Besilate Solution 1.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505611102",
      "ndc_label_name": "Bepotastine Besilate Solution 1.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208063010",
      "ndc_label_name": "Bepotastine Besilate Solution 1.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505611101",
      "ndc_label_name": "Bepotastine Besilate Solution 1.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82260063005",
      "ndc_label_name": "Bepotastine Besilate Solution 1.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378705535",
      "ndc_label_name": "Bepotastine Besilate Solution 1.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069071201",
      "ndc_label_name": "Bepotastine Besilate Solution 1.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378705567",
      "ndc_label_name": "Bepotastine Besilate Solution 1.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332059810",
      "ndc_label_name": "Bepotastine Besilate Solution 1.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332059805",
      "ndc_label_name": "Bepotastine Besilate Solution 1.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069071101",
      "ndc_label_name": "Bepotastine Besilate Solution 1.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82260063010",
      "ndc_label_name": "Bepotastine Besilate Solution 1.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208062902",
      "ndc_label_name": "Bepreve Solution 1.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208062901",
      "ndc_label_name": "Bepreve Solution 1.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452105002",
      "ndc_label_name": "Bergamot Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452105001",
      "ndc_label_name": "Bergamot Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00395203091",
      "ndc_label_name": "Bergamot Oil Oil",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63833082502",
      "ndc_label_name": "Berinert KIT 500 UNIT Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840020002",
      "ndc_label_name": "Bermuda Grass Solution 10000 BAU/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840020004",
      "ndc_label_name": "Bermuda Grass Solution 10000 BAU/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071152905",
      "ndc_label_name": "Besivance Suspension 0.6 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208044605",
      "ndc_label_name": "Besivance Suspension 0.6 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090124100",
      "ndc_label_name": "Besivance Suspension 0.6 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118999305",
      "ndc_label_name": "Besivance Suspension 0.6 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73536050001",
      "ndc_label_name": "Besremi Solution Prefilled Syringe 500 MCG/ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927235600",
      "ndc_label_name": "Beta Carotene BEADS 10 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779236504",
      "ndc_label_name": "Beta Cyclodextrin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779236509",
      "ndc_label_name": "Beta Cyclodextrin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779236505",
      "ndc_label_name": "Beta Cyclodextrin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927249200",
      "ndc_label_name": "Beta Cyclodextrin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779236503",
      "ndc_label_name": "Beta Cyclodextrin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779236508",
      "ndc_label_name": "Beta Cyclodextrin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927294900",
      "ndc_label_name": "Beta Glucan POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552140702",
      "ndc_label_name": "Beta Glucan POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552140701",
      "ndc_label_name": "Beta Glucan POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552140704",
      "ndc_label_name": "Beta Glucan POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927524300",
      "ndc_label_name": "Beta Glucan Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552140705",
      "ndc_label_name": "Beta Glucan POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452106503",
      "ndc_label_name": "Betahistine Dihydrochloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552082602",
      "ndc_label_name": "Betahistine Dihydrochloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452106502",
      "ndc_label_name": "Betahistine Dihydrochloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991160009",
      "ndc_label_name": "Betahistine Dihydrochloride Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552082604",
      "ndc_label_name": "Betahistine Dihydrochloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991160004",
      "ndc_label_name": "Betahistine Dihydrochloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552082603",
      "ndc_label_name": "Betahistine Dihydrochloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452106501",
      "ndc_label_name": "Betahistine Dihydrochloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991160005",
      "ndc_label_name": "Betahistine Dihydrochloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927188200",
      "ndc_label_name": "Betahistine Dihydrochloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452106504",
      "ndc_label_name": "Betahistine Dihydrochloride Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927426000",
      "ndc_label_name": "Betahistine Dihydrochloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552082605",
      "ndc_label_name": "Betahistine Dihydrochloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991160002",
      "ndc_label_name": "Betahistine Dihydrochloride Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144014801",
      "ndc_label_name": "Betahistine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779293401",
      "ndc_label_name": "Betahistine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779293404",
      "ndc_label_name": "Betahistine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779293405",
      "ndc_label_name": "Betahistine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779293403",
      "ndc_label_name": "Betahistine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452080302",
      "ndc_label_name": "Betaine Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779104005",
      "ndc_label_name": "Betaine Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991275202",
      "ndc_label_name": "Betaine Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927254800",
      "ndc_label_name": "Betaine Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779104008",
      "ndc_label_name": "Betaine Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991275201",
      "ndc_label_name": "Betaine Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552109805",
      "ndc_label_name": "Betaine Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452105505",
      "ndc_label_name": "Betaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452105502",
      "ndc_label_name": "Betaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452105501",
      "ndc_label_name": "Betaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452105504",
      "ndc_label_name": "Betaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927155700",
      "ndc_label_name": "Betaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713035281",
      "ndc_label_name": "Betaine Powder Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55792000201",
      "ndc_label_name": "Betaine Powder Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72647090001",
      "ndc_label_name": "Betaine Powder Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71863011518",
      "ndc_label_name": "Betaine Powder Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420076501",
      "ndc_label_name": "Betalido KIT 6 & 1 MG/ML-% INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425022301",
      "ndc_label_name": "Betalido Kit 6 & 1 MG/ML-% Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552062801",
      "ndc_label_name": "Betamethasone Acetate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779012606",
      "ndc_label_name": "Betamethasone Acetate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991250102",
      "ndc_label_name": "Betamethasone Acetate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779012601",
      "ndc_label_name": "Betamethasone Acetate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452107204",
      "ndc_label_name": "Betamethasone Acetate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779012605",
      "ndc_label_name": "Betamethasone Acetate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779012603",
      "ndc_label_name": "Betamethasone Acetate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552062802",
      "ndc_label_name": "Betamethasone Acetate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991250103",
      "ndc_label_name": "Betamethasone Acetate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452107201",
      "ndc_label_name": "Betamethasone Acetate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452107203",
      "ndc_label_name": "Betamethasone Acetate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779012604",
      "ndc_label_name": "Betamethasone Acetate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452107202",
      "ndc_label_name": "Betamethasone Acetate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927195400",
      "ndc_label_name": "Betamethasone Acetate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991250101",
      "ndc_label_name": "Betamethasone Acetate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62295301802",
      "ndc_label_name": "Betamethasone Combo Suspension 6 (3-3) MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62295328407",
      "ndc_label_name": "Betamethasone Combo SUSPENSION 7 (4-3) MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672131001",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959012450",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802037635",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462029052",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629861301",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026515",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026550",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090209100",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629861401",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462029017",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162140502",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788724105",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802037632",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090327000",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205027515",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788767005",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162140504",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090523200",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672131003",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356064115",
      "ndc_label_name": "Betamethasone Dipropionate Aug Gel 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999075715",
      "ndc_label_name": "Betamethasone Dipropionate Aug Gel 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672130903",
      "ndc_label_name": "Betamethasone Dipropionate Aug GEL 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672130901",
      "ndc_label_name": "Betamethasone Dipropionate Aug GEL 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026730",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672134003",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672134004",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52565002359",
      "ndc_label_name": "Betamethasone Dipropionate Aug Lotion 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118999503",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026760",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118999506",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52565002329",
      "ndc_label_name": "Betamethasone Dipropionate Aug Lotion 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61748048030",
      "ndc_label_name": "Betamethasone Dipropionate Aug Lotion 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61748048060",
      "ndc_label_name": "Betamethasone Dipropionate Aug Lotion 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180094701",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35573010749",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993089749",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35573010715",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026815",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090751700",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168026850",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090678700",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472038215",
      "ndc_label_name": "Betamethasone Dipropionate Aug OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180094702",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472038245",
      "ndc_label_name": "Betamethasone Dipropionate Aug OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739099665",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993089715",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713065915",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168005546",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714099602",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472038015",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090468000",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168005515",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090327600",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714099601",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713065937",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713075937",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090403800",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472038045",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672127406",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090023500",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002094163",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090183900",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002094167",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090752500",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710123301",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713075915",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710123304",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090037300",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959072145",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672127401",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090218200",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959072115",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407027315",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407027345",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168005760",
      "ndc_label_name": "Betamethasone Dipropionate LOTION 0.05 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713072853",
      "ndc_label_name": "Betamethasone Dipropionate Lotion 0.05 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802002146",
      "ndc_label_name": "Betamethasone Dipropionate LOTION 0.05 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713080753",
      "ndc_label_name": "Betamethasone Dipropionate LOTION 0.05 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61748047560",
      "ndc_label_name": "Betamethasone Dipropionate Lotion 0.05 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168005646",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168005615",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802050584",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817082445",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578009306",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472038115",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959096250",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802050514",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002072363",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090023600",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629932301",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817082415",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472038145",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162141504",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959026200",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356049615",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002072367",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959026215",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629932401",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267129601",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578009301",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335271501",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162141502",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452107501",
      "ndc_label_name": "Betamethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779001706",
      "ndc_label_name": "Betamethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779001704",
      "ndc_label_name": "Betamethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779001701",
      "ndc_label_name": "Betamethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452107503",
      "ndc_label_name": "Betamethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102304",
      "ndc_label_name": "Betamethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927145400",
      "ndc_label_name": "Betamethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779001703",
      "ndc_label_name": "Betamethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452107506",
      "ndc_label_name": "Betamethasone Dipropionate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452107502",
      "ndc_label_name": "Betamethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102301",
      "ndc_label_name": "Betamethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552002202",
      "ndc_label_name": "Betamethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552002209",
      "ndc_label_name": "Betamethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552002201",
      "ndc_label_name": "Betamethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102305",
      "ndc_label_name": "Betamethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102302",
      "ndc_label_name": "Betamethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102303",
      "ndc_label_name": "Betamethasone Dipropionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452107003",
      "ndc_label_name": "Betamethasone POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452107005",
      "ndc_label_name": "Betamethasone POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452107006",
      "ndc_label_name": "Betamethasone POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452107002",
      "ndc_label_name": "Betamethasone POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452107001",
      "ndc_label_name": "Betamethasone Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71283062002",
      "ndc_label_name": "Betamethasone Sod Phos & Acet Suspension 6 (3-3) MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754506001",
      "ndc_label_name": "Betamethasone Sod Phos & Acet Suspension 6 (3-3) MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517072001",
      "ndc_label_name": "Betamethasone Sod Phos & Acet SUSPENSION 6 (3-3) MG/ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517079101",
      "ndc_label_name": "Betamethasone Sod Phos & Acet Suspension 6 (3-3) MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517079901",
      "ndc_label_name": "Betamethasone Sod Phos & Acet Suspension 6 (3-3) MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518050600",
      "ndc_label_name": "Betamethasone Sod Phos & Acet Suspension 6 (3-3) MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518295200",
      "ndc_label_name": "Betamethasone Sod Phos & Acet Suspension 6 (3-3) MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019500",
      "ndc_label_name": "Betamethasone Sodium Phosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452107701",
      "ndc_label_name": "Betamethasone Sodium Phosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019505",
      "ndc_label_name": "Betamethasone Sodium Phosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019506",
      "ndc_label_name": "Betamethasone Sodium Phosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552006404",
      "ndc_label_name": "Betamethasone Sodium Phosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102404",
      "ndc_label_name": "Betamethasone Sodium Phosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552006402",
      "ndc_label_name": "Betamethasone Sodium Phosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019501",
      "ndc_label_name": "Betamethasone Sodium Phosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019503",
      "ndc_label_name": "Betamethasone Sodium Phosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452107704",
      "ndc_label_name": "Betamethasone Sodium Phosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552006403",
      "ndc_label_name": "Betamethasone Sodium Phosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552006401",
      "ndc_label_name": "Betamethasone Sodium Phosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452107702",
      "ndc_label_name": "Betamethasone Sodium Phosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102405",
      "ndc_label_name": "Betamethasone Sodium Phosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102401",
      "ndc_label_name": "Betamethasone Sodium Phosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452107706",
      "ndc_label_name": "Betamethasone Sodium Phosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452107705",
      "ndc_label_name": "Betamethasone Sodium Phosphate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102402",
      "ndc_label_name": "Betamethasone Sodium Phosphate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102406",
      "ndc_label_name": "Betamethasone Sodium Phosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927195100",
      "ndc_label_name": "Betamethasone Sodium Phosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472037045",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090313401",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168004046",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090164700",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168004015",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090379401",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472037015",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090023700",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090030901",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959026300",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788845001",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959026301",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713032615",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205004015",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713032637",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518313700",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090469600",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002092163",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672126906",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788731201",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904077645",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788731204",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788845004",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672126901",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002092167",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332070850",
      "ndc_label_name": "Betamethasone Valerate Foam 0.12 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742031550",
      "ndc_label_name": "Betamethasone Valerate Foam 0.12 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742031501",
      "ndc_label_name": "Betamethasone Valerate Foam 0.12 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378818050",
      "ndc_label_name": "Betamethasone Valerate Foam 0.12 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118993505",
      "ndc_label_name": "Betamethasone Valerate FOAM 0.12 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802005302",
      "ndc_label_name": "Betamethasone Valerate FOAM 0.12 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672418807",
      "ndc_label_name": "Betamethasone Valerate FOAM 0.12 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802005301",
      "ndc_label_name": "Betamethasone Valerate FOAM 0.12 % EXTERNAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332070831",
      "ndc_label_name": "Betamethasone Valerate Foam 0.12 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700014119",
      "ndc_label_name": "Betamethasone Valerate Foam 0.12 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700014120",
      "ndc_label_name": "Betamethasone Valerate Foam 0.12 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378818099",
      "ndc_label_name": "Betamethasone Valerate Foam 0.12 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672418803",
      "ndc_label_name": "Betamethasone Valerate FOAM 0.12 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168004160",
      "ndc_label_name": "Betamethasone Valerate Lotion 0.1 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959024303",
      "ndc_label_name": "Betamethasone Valerate Lotion 0.1 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54879000460",
      "ndc_label_name": "Betamethasone Valerate Lotion 0.1 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168003346",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788782701",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713032715",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168003315",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472037115",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002084563",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788849601",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788782704",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713032737",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472037145",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788849604",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205036415",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552002301",
      "ndc_label_name": "Betamethasone Valerate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452108003",
      "ndc_label_name": "Betamethasone Valerate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779000406",
      "ndc_label_name": "Betamethasone Valerate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552002305",
      "ndc_label_name": "Betamethasone Valerate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779000403",
      "ndc_label_name": "Betamethasone Valerate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779000401",
      "ndc_label_name": "Betamethasone Valerate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552002303",
      "ndc_label_name": "Betamethasone Valerate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779000404",
      "ndc_label_name": "Betamethasone Valerate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779000405",
      "ndc_label_name": "Betamethasone Valerate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452108005",
      "ndc_label_name": "Betamethasone Valerate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991301701",
      "ndc_label_name": "Betamethasone Valerate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991301703",
      "ndc_label_name": "Betamethasone Valerate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452108001",
      "ndc_label_name": "Betamethasone Valerate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452108002",
      "ndc_label_name": "Betamethasone Valerate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552002302",
      "ndc_label_name": "Betamethasone Valerate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927116000",
      "ndc_label_name": "Betamethasone Valerate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991301702",
      "ndc_label_name": "Betamethasone Valerate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927121500",
      "ndc_label_name": "Betanaphthol POWDER 99 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70515011906",
      "ndc_label_name": "Betapace AF TABLET 120 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70515011606",
      "ndc_label_name": "Betapace AF TABLET 160 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70515011506",
      "ndc_label_name": "Betapace AF TABLET 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70515010910",
      "ndc_label_name": "Betapace TABLET 120 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70515010610",
      "ndc_label_name": "Betapace TABLET 160 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70515010510",
      "ndc_label_name": "Betapace TABLET 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419052401",
      "ndc_label_name": "Betaseron KIT 0.3 MG Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419052435",
      "ndc_label_name": "Betaseron KIT 0.3 MG Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314024503",
      "ndc_label_name": "Betaxolol HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478070510",
      "ndc_label_name": "Betaxolol HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478070511",
      "ndc_label_name": "Betaxolol HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314024501",
      "ndc_label_name": "Betaxolol HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314024502",
      "ndc_label_name": "Betaxolol HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10702001301",
      "ndc_label_name": "Betaxolol HCl TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429075301",
      "ndc_label_name": "Betaxolol HCl Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658070001",
      "ndc_label_name": "Betaxolol HCl TABLET 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135062301",
      "ndc_label_name": "Betaxolol HCl TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806003801",
      "ndc_label_name": "Betaxolol HCl TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135062401",
      "ndc_label_name": "Betaxolol HCl TABLET 20 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658070101",
      "ndc_label_name": "Betaxolol HCl TABLET 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10702001401",
      "ndc_label_name": "Betaxolol HCl TABLET 20 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806003901",
      "ndc_label_name": "Betaxolol HCl TABLET 20 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452108304",
      "ndc_label_name": "Bethanechol Chloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452108305",
      "ndc_label_name": "Bethanechol Chloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452108302",
      "ndc_label_name": "Bethanechol Chloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452108303",
      "ndc_label_name": "Bethanechol Chloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927209700",
      "ndc_label_name": "Bethanechol Chloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452108306",
      "ndc_label_name": "Bethanechol Chloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991153004",
      "ndc_label_name": "Bethanechol Chloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991153002",
      "ndc_label_name": "Bethanechol Chloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991153003",
      "ndc_label_name": "Bethanechol Chloride POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687068901",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335084601",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746057201",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832051101",
      "ndc_label_name": "Bethanechol Chloride TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135051601",
      "ndc_label_name": "Bethanechol Chloride TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155093501",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527134001",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084036511",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629929301",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084036501",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135075612",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832051100",
      "ndc_label_name": "Bethanechol Chloride TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832051189",
      "ndc_label_name": "Bethanechol Chloride TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51293064601",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687068911",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629202301",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162057210",
      "ndc_label_name": "Bethanechol Chloride TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832051200",
      "ndc_label_name": "Bethanechol Chloride TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904617861",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135051705",
      "ndc_label_name": "Bethanechol Chloride TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629202401",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527135601",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832051289",
      "ndc_label_name": "Bethanechol Chloride TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51293064701",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135075712",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832051201",
      "ndc_label_name": "Bethanechol Chloride TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687070011",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980016201",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162057310",
      "ndc_label_name": "Bethanechol Chloride TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135051701",
      "ndc_label_name": "Bethanechol Chloride TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084070401",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155093601",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084070411",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746057301",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687070001",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51293064501",
      "ndc_label_name": "Bethanechol Chloride Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746057101",
      "ndc_label_name": "Bethanechol Chloride Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527133201",
      "ndc_label_name": "Bethanechol Chloride Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155093401",
      "ndc_label_name": "Bethanechol Chloride Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980016001",
      "ndc_label_name": "Bethanechol Chloride Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135051501",
      "ndc_label_name": "Bethanechol Chloride TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832051000",
      "ndc_label_name": "Bethanechol Chloride TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135075590",
      "ndc_label_name": "Bethanechol Chloride Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629202201",
      "ndc_label_name": "Bethanechol Chloride Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162057110",
      "ndc_label_name": "Bethanechol Chloride TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832051301",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155093701",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527132901",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746057401",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135051801",
      "ndc_label_name": "Bethanechol Chloride TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51293064801",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135075812",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832051300",
      "ndc_label_name": "Bethanechol Chloride TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832051389",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629202501",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980016301",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162057410",
      "ndc_label_name": "Bethanechol Chloride TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10122082056",
      "ndc_label_name": "Bethkis Nebulization Solution 300 MG/4ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10122082028",
      "ndc_label_name": "Bethkis Nebulization Solution 300 MG/4ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10122082004",
      "ndc_label_name": "Bethkis Nebulization Solution 300 MG/4ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82584000105",
      "ndc_label_name": "Betimol Solution 0.25 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76478000105",
      "ndc_label_name": "Betimol Solution 0.25 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76478000210",
      "ndc_label_name": "Betimol Solution 0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76478000205",
      "ndc_label_name": "Betimol Solution 0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82584000215",
      "ndc_label_name": "Betimol Solution 0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76478000215",
      "ndc_label_name": "Betimol Solution 0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82584000205",
      "ndc_label_name": "Betimol Solution 0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065024610",
      "ndc_label_name": "Betoptic-S Suspension 0.25 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065024615",
      "ndc_label_name": "Betoptic-S Suspension 0.25 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078072910",
      "ndc_label_name": "Betoptic-S Suspension 0.25 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078072915",
      "ndc_label_name": "Betoptic-S Suspension 0.25 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71449009135",
      "ndc_label_name": "Bevacizumab Solution Prefilled Syringe 3.75 MG/0.15ML Intravitreal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310460039",
      "ndc_label_name": "Bevespi Aerosphere Aerosol 9-4.8 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310460012",
      "ndc_label_name": "Bevespi Aerosphere Aerosol 9-4.8 MCG/ACT Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407082690",
      "ndc_label_name": "Bexagliflozin Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407082630",
      "ndc_label_name": "Bexagliflozin Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407091830",
      "ndc_label_name": "Bexagliflozin Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407091890",
      "ndc_label_name": "Bexagliflozin Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054039925",
      "ndc_label_name": "Bexarotene Capsule 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43975031510",
      "ndc_label_name": "Bexarotene Capsule 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291007201",
      "ndc_label_name": "Bexarotene Capsule 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832028500",
      "ndc_label_name": "Bexarotene Capsule 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682000310",
      "ndc_label_name": "Bexarotene Capsule 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378695501",
      "ndc_label_name": "Bexarotene CAPSULE 75 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591283201",
      "ndc_label_name": "Bexarotene Capsule 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722038001",
      "ndc_label_name": "Bexarotene Capsule 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238125001",
      "ndc_label_name": "Bexarotene Capsule 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682000260",
      "ndc_label_name": "Bexarotene Gel 1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238208806",
      "ndc_label_name": "Bexarotene Gel 1 % External",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160097602",
      "ndc_label_name": "Bexsero Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58160097620",
      "ndc_label_name": "Bexsero Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419040701",
      "ndc_label_name": "Beyaz TABLET 3-0.02-0.451 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419040703",
      "ndc_label_name": "Beyaz TABLET 3-0.02-0.451 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452109503",
      "ndc_label_name": "BHA FLAKES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452109502",
      "ndc_label_name": "BHA FLAKES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452109501",
      "ndc_label_name": "BHA FLAKES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00395602258",
      "ndc_label_name": "BHRT Base Cream",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00395602257",
      "ndc_label_name": "BHRT Base Cream",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452110501",
      "ndc_label_name": "BHT GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452110503",
      "ndc_label_name": "BHT GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452110502",
      "ndc_label_name": "BHT GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452110504",
      "ndc_label_name": "BHT GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729002310",
      "ndc_label_name": "Bicalutamide TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714081601",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429017701",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714081602",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904601946",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335048583",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429017705",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729002301",
      "ndc_label_name": "Bicalutamide TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407001030",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505264203",
      "ndc_label_name": "Bicalutamide TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335048588",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518299300",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559089030",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518299301",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429017730",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505264201",
      "ndc_label_name": "Bicalutamide TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62175013232",
      "ndc_label_name": "Bicalutamide TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804008290",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793060202",
      "ndc_label_name": "Bicillin C-R 900/300 SUSPENSION 900000-300000 UNIT/2ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793060210",
      "ndc_label_name": "Bicillin C-R 900/300 SUSPENSION 900000-300000 UNIT/2ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793060010",
      "ndc_label_name": "Bicillin C-R SUSPENSION 1200000 UNIT/2ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793060110",
      "ndc_label_name": "Bicillin C-R SUSPENSION 1200000 UNIT/2ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793060102",
      "ndc_label_name": "Bicillin C-R SUSPENSION 1200000 UNIT/2ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793060002",
      "ndc_label_name": "Bicillin C-R SUSPENSION 1200000 UNIT/2ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090101601",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 1200000 UNIT/2ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569587701",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 1200000 UNIT/2ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793070102",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 1200000 UNIT/2ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793070110",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 1200000 UNIT/2ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090101600",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 1200000 UNIT/2ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569587700",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 1200000 UNIT/2ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793070210",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 2400000 UNIT/4ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793070204",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 2400000 UNIT/4ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569587600",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 600000 UNIT/ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793070001",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 600000 UNIT/ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60793070010",
      "ndc_label_name": "Bicillin L-A Suspension Prefilled Syringe 600000 UNIT/ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155058931",
      "ndc_label_name": "BiCNU Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155026141",
      "ndc_label_name": "BiCNU Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24338001018",
      "ndc_label_name": "BiDil Tablet 20-37.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24338001009",
      "ndc_label_name": "BiDil Tablet 20-37.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308075130",
      "ndc_label_name": "Bijuva Capsule 0.5-100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50261021130",
      "ndc_label_name": "Bijuva Capsule 1-100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308075030",
      "ndc_label_name": "Bijuva Capsule 1-100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61958250601",
      "ndc_label_name": "Biktarvy Tablet 30-120-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61958250501",
      "ndc_label_name": "Biktarvy Tablet 30-120-15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518308001",
      "ndc_label_name": "Biktarvy Tablet 50-200-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090624700",
      "ndc_label_name": "Biktarvy Tablet 50-200-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518308000",
      "ndc_label_name": "Biktarvy Tablet 50-200-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61958250103",
      "ndc_label_name": "Biktarvy Tablet 50-200-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518308002",
      "ndc_label_name": "Biktarvy Tablet 50-200-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61958250101",
      "ndc_label_name": "Biktarvy TABLET 50-200-25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "78206019301",
      "ndc_label_name": "Bildyos Solution Prefilled Syringe 60 MG/ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "78206019501",
      "ndc_label_name": "Bilprevda Solution 120 MG/1.7ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419074701",
      "ndc_label_name": "Biltricide Tablet 600 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779306609",
      "ndc_label_name": "Bimatoprost Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779306600",
      "ndc_label_name": "Bimatoprost Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779306606",
      "ndc_label_name": "Bimatoprost Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779306603",
      "ndc_label_name": "Bimatoprost Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052027601",
      "ndc_label_name": "Bimatoprost Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505058301",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862080205",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332050725",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571012835",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571012821",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571012828",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266024101",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862080244",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069040301",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069040101",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332050705",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505058304",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180042903",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862080210",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266014001",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180042901",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180042902",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069040201",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266013901",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50474078184",
      "ndc_label_name": "Bimzelx Solution Auto-Injector 160 MG/ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50474078185",
      "ndc_label_name": "Bimzelx Solution Auto-Injector 160 MG/ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50474078284",
      "ndc_label_name": "Bimzelx Solution Auto-Injector 320 MG/2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50474078078",
      "ndc_label_name": "Bimzelx Solution Prefilled Syringe 160 MG/ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50474078079",
      "ndc_label_name": "Bimzelx Solution Prefilled Syringe 160 MG/ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50474078378",
      "ndc_label_name": "Bimzelx Solution Prefilled Syringe 320 MG/2ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70539040000",
      "ndc_label_name": "Binosto Tablet Effervescent 70 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17139040004",
      "ndc_label_name": "Binosto Tablet Effervescent 70 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70539040004",
      "ndc_label_name": "Binosto Tablet Effervescent 70 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17139040000",
      "ndc_label_name": "Binosto Tablet Effervescent 70 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17238090030",
      "ndc_label_name": "Bio Glo Strip 1 MG Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17238090011",
      "ndc_label_name": "Bio Glo Strip 1 MG Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45737040860",
      "ndc_label_name": "Biocel Tablet Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552096307",
      "ndc_label_name": "Bioflavonoid Citrus POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "64661079330",
      "ndc_label_name": "Biopar delta-Forte Capsule Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991263202",
      "ndc_label_name": "Biore Hydrating Moisturizer Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10695032510",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779200408",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10695032570",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779200404",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779200400",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452111502",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10695030610",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779200405",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779200403",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452111504",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779200406",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592005225",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592005222",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592005211",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10695030650",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991122002",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991122003",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452111503",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991122001",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10695032550",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452111505",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927132300",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991122004",
      "ndc_label_name": "Biotin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552065405",
      "ndc_label_name": "Biotin-D Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552065406",
      "ndc_label_name": "Biotin-D Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552065401",
      "ndc_label_name": "Biotin-D Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552065402",
      "ndc_label_name": "Biotin-D Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552065404",
      "ndc_label_name": "Biotin-D Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "22840560805",
      "ndc_label_name": "Bipolaris sorokin (Diagnostic) Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840560802",
      "ndc_label_name": "Bipolaris sorokiniana Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742028313",
      "ndc_label_name": "Bis Subcit-Metronid-Tetracyc Capsule 140-125-125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61269038512",
      "ndc_label_name": "Bis Subcit-Metronid-Tetracyc Capsule 140-125-125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927412700",
      "ndc_label_name": "Bisabolol, Alpha-L Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927255300",
      "ndc_label_name": "Bisacodyl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452080401",
      "ndc_label_name": "Bismuth Citrate (Bulk) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452080403",
      "ndc_label_name": "Bismuth Citrate (Bulk) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452080402",
      "ndc_label_name": "Bismuth Citrate (Bulk) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927442800",
      "ndc_label_name": "Bismuth Citrate (Bulk) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452080404",
      "ndc_label_name": "Bismuth Citrate (Bulk) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927517900",
      "ndc_label_name": "Bismuth Citrate (Bulk) Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552045506",
      "ndc_label_name": "Bismuth Subcarbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779065905",
      "ndc_label_name": "Bismuth Subcarbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452115202",
      "ndc_label_name": "Bismuth Subcarbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452115203",
      "ndc_label_name": "Bismuth Subcarbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991284404",
      "ndc_label_name": "Bismuth Subcarbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991284403",
      "ndc_label_name": "Bismuth Subcarbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284402",
      "ndc_label_name": "Bismuth Subcarbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452115204",
      "ndc_label_name": "Bismuth Subcarbonate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927111900",
      "ndc_label_name": "Bismuth Subcarbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779065908",
      "ndc_label_name": "Bismuth Subcarbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284401",
      "ndc_label_name": "Bismuth Subcarbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452115201",
      "ndc_label_name": "Bismuth Subcarbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552045504",
      "ndc_label_name": "Bismuth Subcarbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779104608",
      "ndc_label_name": "Bismuth Subgallate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779104604",
      "ndc_label_name": "Bismuth Subgallate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779104605",
      "ndc_label_name": "Bismuth Subgallate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452115501",
      "ndc_label_name": "Bismuth Subgallate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552020207",
      "ndc_label_name": "Bismuth Subgallate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452115504",
      "ndc_label_name": "Bismuth Subgallate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452115502",
      "ndc_label_name": "Bismuth Subgallate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552020205",
      "ndc_label_name": "Bismuth Subgallate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927126200",
      "ndc_label_name": "Bismuth Subgallate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452115503",
      "ndc_label_name": "Bismuth Subgallate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991164802",
      "ndc_label_name": "Bismuth Subgallate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991164804",
      "ndc_label_name": "Bismuth Subgallate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991164803",
      "ndc_label_name": "Bismuth Subgallate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452118003",
      "ndc_label_name": "Bismuth Subnitrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779104708",
      "ndc_label_name": "Bismuth Subnitrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779104704",
      "ndc_label_name": "Bismuth Subnitrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452118001",
      "ndc_label_name": "Bismuth Subnitrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779104705",
      "ndc_label_name": "Bismuth Subnitrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552016209",
      "ndc_label_name": "Bismuth Subnitrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991164702",
      "ndc_label_name": "Bismuth Subnitrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927114500",
      "ndc_label_name": "Bismuth Subnitrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452118004",
      "ndc_label_name": "Bismuth Subnitrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991164701",
      "ndc_label_name": "Bismuth Subnitrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452118002",
      "ndc_label_name": "Bismuth Subnitrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991164704",
      "ndc_label_name": "Bismuth Subnitrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452119002",
      "ndc_label_name": "Bismuth Subsalicylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991157106",
      "ndc_label_name": "Bismuth Subsalicylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452119003",
      "ndc_label_name": "Bismuth Subsalicylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452119001",
      "ndc_label_name": "Bismuth Subsalicylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452119104",
      "ndc_label_name": "Bismuth Subsalicylate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452119102",
      "ndc_label_name": "Bismuth Subsalicylate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452119103",
      "ndc_label_name": "Bismuth Subsalicylate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991157102",
      "ndc_label_name": "Bismuth Subsalicylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991157101",
      "ndc_label_name": "Bismuth Subsalicylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452119105",
      "ndc_label_name": "Bismuth Subsalicylate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991157105",
      "ndc_label_name": "Bismuth Subsalicylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991157103",
      "ndc_label_name": "Bismuth Subsalicylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452119106",
      "ndc_label_name": "Bismuth Subsalicylate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991157104",
      "ndc_label_name": "Bismuth Subsalicylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927310200",
      "ndc_label_name": "Bismuth Subsalicylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884015124",
      "ndc_label_name": "Bismuth/Metronidaz/Tetracyclin Capsule 140-125-125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884015154",
      "ndc_label_name": "Bismuth/Metronidaz/Tetracyclin Capsule 140-125-125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779314204",
      "ndc_label_name": "Bisoprolol Fumarate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779314203",
      "ndc_label_name": "Bisoprolol Fumarate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779314209",
      "ndc_label_name": "Bisoprolol Fumarate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779314205",
      "ndc_label_name": "Bisoprolol Fumarate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779314208",
      "ndc_label_name": "Bisoprolol Fumarate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578011206",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714053001",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300012701",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300012713",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817027110",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714053002",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008701",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407064601",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332060430",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547061703",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332060431",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407064630",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980071001",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547061710",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954045620",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954045610",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70095001901",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578011201",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70095001902",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817027130",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888009330",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980071003",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789039582",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008730",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888009301",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817026830",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 2.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687067921",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300012601",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714052902",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547061610",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547061603",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817027030",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714052901",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300012613",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008601",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407064530",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999086600",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162217701",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268012711",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578011101",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187087190",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268012715",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70095002001",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332060330",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817027010",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407064501",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332060331",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578011106",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980070903",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954045520",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888009230",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980070901",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687067911",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789039282",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788867101",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70095002002",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008630",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954045510",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919078790",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888009201",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300018913",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 10-6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300018905",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 10-6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135074230",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135074205",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093324356",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799092201",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300018901",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 10-6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378050505",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378050501",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090603000",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578011501",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799092230",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462088030",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799092202",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462088001",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518194701",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518194700",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462088005",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518320700",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090079900",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578011505",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090590500",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954041410",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954041440",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954041430",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959024130",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578011506",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300018705",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 2.5-6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135074005",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462087805",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378050101",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799092002",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090079600",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799092030",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093324101",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462087830",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300018701",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 2.5-6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518333300",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300018713",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 2.5-6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954041240",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462087801",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090647800",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378050105",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578011305",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578011306",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954041230",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135074001",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578011301",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954041210",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799092001",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300018813",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 5-6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090584900",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378050305",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799092102",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135074105",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378050301",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954041330",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093324201",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799092101",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090641302",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300018801",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 5-6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090078902",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090584902",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300018805",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 5-6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578011406",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135074101",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090078900",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090735702",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959033730",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578011405",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090735700",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959033710",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954041310",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799092130",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462087901",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289063030",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 5-6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462087930",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090641300",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289063090",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 5-6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954041340",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462087905",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578011401",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927344700",
      "ndc_label_name": "Bitter Drug POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779289305",
      "ndc_label_name": "Bitter Orange POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779289303",
      "ndc_label_name": "Bitter Orange POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779289304",
      "ndc_label_name": "Bitter Orange POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779289306",
      "ndc_label_name": "Bitter Orange POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779289308",
      "ndc_label_name": "Bitter Orange POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927351900",
      "ndc_label_name": "Bitter Stop Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72467010855",
      "ndc_label_name": "Bitter-Bloc Pure Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72467010822",
      "ndc_label_name": "Bitter-Bloc Pure Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467010840",
      "ndc_label_name": "Bitter-Bloc Pure Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72467010825",
      "ndc_label_name": "Bitter-Bloc Pure Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72467010850",
      "ndc_label_name": "Bitter-Bloc Pure Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72467007590",
      "ndc_label_name": "Bitter-Bloc WS Concentrate",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467007580",
      "ndc_label_name": "Bitter-Bloc WS Concentrate",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467007585",
      "ndc_label_name": "Bitter-Bloc WS Concentrate",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467007595",
      "ndc_label_name": "Bitter-Bloc WS Concentrate",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467010650",
      "ndc_label_name": "Bitter-Bloc WS Concentrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72467010655",
      "ndc_label_name": "Bitter-Bloc WS Concentrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72467010640",
      "ndc_label_name": "Bitter-Bloc WS Concentrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72467010625",
      "ndc_label_name": "Bitter-Bloc WS Concentrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467010385",
      "ndc_label_name": "Bitter-Bloc WS/OS Liquid Concentrate",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72467010380",
      "ndc_label_name": "Bitter-Bloc WS/OS Liquid Concentrate",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72467010390",
      "ndc_label_name": "Bitter-Bloc WS/OS Liquid Concentrate",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467010395",
      "ndc_label_name": "Bitter-Bloc WS/OS Liquid Concentrate",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991283302",
      "ndc_label_name": "Bitterness Mask Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991283301",
      "ndc_label_name": "Bitterness Mask Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779284705",
      "ndc_label_name": "Bitterness Reducing Agent POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779284704",
      "ndc_label_name": "Bitterness Reducing Agent POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779284708",
      "ndc_label_name": "Bitterness Reducing Agent POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779298802",
      "ndc_label_name": "Bitterness Suppressor Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452120302",
      "ndc_label_name": "Bitterness Suppressor Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452120301",
      "ndc_label_name": "Bitterness Suppressor Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779298801",
      "ndc_label_name": "Bitterness Suppressor Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86067000007",
      "ndc_label_name": "Bitterness Suppressor Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70860040350",
      "ndc_label_name": "Bivalirudin RTU Solution 250 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860040351",
      "ndc_label_name": "Bivalirudin RTU Solution 250 MG/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69800650302",
      "ndc_label_name": "Bivigam Solution 10 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69800650301",
      "ndc_label_name": "Bivigam Solution 10 GM/100ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69800650201",
      "ndc_label_name": "Bivigam Solution 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69800650202",
      "ndc_label_name": "Bivigam Solution 5 GM/50ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420089201",
      "ndc_label_name": "BL-C Kit Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420079301",
      "ndc_label_name": "BL-Contrast Kit Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840547505",
      "ndc_label_name": "Black Walnut (Diagnostic) Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840349802",
      "ndc_label_name": "Black Walnut Pollen (1:10) Solution 75000 PNU/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840349804",
      "ndc_label_name": "Black Walnut Pollen (1:10) Solution 75000 PNU/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840440104",
      "ndc_label_name": "Black Walnut Pollen (1:20) Solution 75000 PNU/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840440102",
      "ndc_label_name": "Black Walnut Pollen (1:20) Solution 75000 PNU/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840547402",
      "ndc_label_name": "Black Walnut Pollen Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840440004",
      "ndc_label_name": "Black Walnut Pollen Solution 20000 PNU/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840440002",
      "ndc_label_name": "Black Walnut Pollen Solution 20000 PNU/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840349902",
      "ndc_label_name": "Black Walnut Pollen Solution 40000 PNU/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840349904",
      "ndc_label_name": "Black Walnut Pollen Solution 40000 PNU/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840547805",
      "ndc_label_name": "Black Willow (Diagnostic) Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840547802",
      "ndc_label_name": "Black Willow Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840541204",
      "ndc_label_name": "Black/Sweet Birch Pollen Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840541202",
      "ndc_label_name": "Black/Sweet Birch Pollen Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927216800",
      "ndc_label_name": "Blackberry Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11980001105",
      "ndc_label_name": "Bleph-10 Solution 10 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959027200",
      "ndc_label_name": "Bleph-10 Solution 10 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959027201",
      "ndc_label_name": "Bleph-10 Solution 10 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513016001",
      "ndc_label_name": "Blincyto SOLUTION RECONSTITUTED 35 MCG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086473",
      "ndc_label_name": "Blisovi 24 Fe Tablet 1-20 MG-MCG(24) Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086471",
      "ndc_label_name": "Blisovi 24 Fe Tablet 1-20 MG-MCG(24) Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086673",
      "ndc_label_name": "Blisovi Fe 1.5/30 Tablet 1.5-30 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086671",
      "ndc_label_name": "Blisovi Fe 1.5/30 Tablet 1.5-30 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086911",
      "ndc_label_name": "Blisovi Fe 1.5/30 Tablet 1.5-30 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086913",
      "ndc_label_name": "Blisovi Fe 1.5/30 Tablet 1.5-30 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086573",
      "ndc_label_name": "Blisovi FE 1/20 Tablet 1-20 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180086571",
      "ndc_label_name": "Blisovi FE 1/20 Tablet 1-20 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72467012590",
      "ndc_label_name": "Blood Orange OS Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467012580",
      "ndc_label_name": "Blood Orange OS Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467012595",
      "ndc_label_name": "Blood Orange OS Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467012585",
      "ndc_label_name": "Blood Orange OS Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "76420085101",
      "ndc_label_name": "BLT-25 Kit 40 & 0.25 & 1 MG/ML-%-% Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927471900",
      "ndc_label_name": "Blue Agave Organic Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840577005",
      "ndc_label_name": "Blue Crab (Diagnostic) Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927216400",
      "ndc_label_name": "Blueberry Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991258901",
      "ndc_label_name": "Blueberry Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991258902",
      "ndc_label_name": "Blueberry Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00173092245",
      "ndc_label_name": "Blujepa Tablet 750 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219067001",
      "ndc_label_name": "Bomyntra Solution 120 MG/1.7ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219067201",
      "ndc_label_name": "Bomyntra Solution Prefilled Syringe 120 MG/1.7ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55494012060",
      "ndc_label_name": "Bonjesta Tablet Extended Release 20-20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781085289",
      "ndc_label_name": "Bonsity Solution Pen-Injector 560 MCG/2.24ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160084252",
      "ndc_label_name": "Boostrix Suspension Prefilled Syringe 5-2.5-18.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090137701",
      "ndc_label_name": "Boostrix Suspension Prefilled Syringe 5-2.5-18.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58160084243",
      "ndc_label_name": "Boostrix Suspension Prefilled Syringe 5-2.5-18.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090137700",
      "ndc_label_name": "Boostrix Suspension Prefilled Syringe 5-2.5-18.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49452121003",
      "ndc_label_name": "Boric Acid CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452121002",
      "ndc_label_name": "Boric Acid CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452121004",
      "ndc_label_name": "Boric Acid Crystals",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452121001",
      "ndc_label_name": "Boric Acid CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "96295011388",
      "ndc_label_name": "Boric Acid NF Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991164902",
      "ndc_label_name": "Boric Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779006408",
      "ndc_label_name": "Boric Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452123001",
      "ndc_label_name": "Boric Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779006409",
      "ndc_label_name": "Boric Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552034308",
      "ndc_label_name": "Boric Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779006401",
      "ndc_label_name": "Boric Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592001261",
      "ndc_label_name": "Boric Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592001204",
      "ndc_label_name": "Boric Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592001211",
      "ndc_label_name": "Boric Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927201000",
      "ndc_label_name": "Boric Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452123003",
      "ndc_label_name": "Boric Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552034303",
      "ndc_label_name": "Boric Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991164904",
      "ndc_label_name": "Boric Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452123002",
      "ndc_label_name": "Boric Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452123004",
      "ndc_label_name": "Boric Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991164905",
      "ndc_label_name": "Boric Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991164901",
      "ndc_label_name": "Boric Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552034306",
      "ndc_label_name": "Boric Acid POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60592001201",
      "ndc_label_name": "Boric Acid Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00395030312",
      "ndc_label_name": "Boric Acid Topical POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00395030396",
      "ndc_label_name": "Boric Acid Topical POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927429200",
      "ndc_label_name": "Boron Amorphous Fine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927334300",
      "ndc_label_name": "Boron Citrate POWDER 5 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266024401",
      "ndc_label_name": "Bortezomib Solution 3.5 MG/1.4ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323072110",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598086560",
      "ndc_label_name": "Bortezomib Solution Reconstituted 3.5 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591251260",
      "ndc_label_name": "Bosentan Tablet 125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335003986",
      "ndc_label_name": "Bosentan Tablet 125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382044714",
      "ndc_label_name": "Bosentan Tablet 125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884005902",
      "ndc_label_name": "Bosentan Tablet 125 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591251160",
      "ndc_label_name": "Bosentan Tablet 62.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054052021",
      "ndc_label_name": "Bosentan Tablet 62.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382044614",
      "ndc_label_name": "Bosentan Tablet 62.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335003886",
      "ndc_label_name": "Bosentan Tablet 62.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884005802",
      "ndc_label_name": "Bosentan Tablet 62.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180034013",
      "ndc_label_name": "Bosentan Tablet Soluble 32 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069101415",
      "ndc_label_name": "Bosulif Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069050430",
      "ndc_label_name": "Bosulif Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069013501",
      "ndc_label_name": "Bosulif Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069019301",
      "ndc_label_name": "Bosulif Tablet 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069013601",
      "ndc_label_name": "Bosulif Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779269406",
      "ndc_label_name": "Boswellia Serrata Extract POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779269408",
      "ndc_label_name": "Boswellia Serrata Extract POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779269404",
      "ndc_label_name": "Boswellia Serrata Extract POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927306400",
      "ndc_label_name": "Boswellia Serrata Extract POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779269409",
      "ndc_label_name": "Boswellia Serrata Extract POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779269405",
      "ndc_label_name": "Boswellia Serrata Extract POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779269401",
      "ndc_label_name": "Boswellia Serrata Extract POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288123905",
      "ndc_label_name": "Boswellia Serrata Extract POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779580401",
      "ndc_label_name": "Bottle 120ml/Spray/Clr Plastic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779582601",
      "ndc_label_name": "Bottle 2oz/Blue Glass/Dropper",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779597701",
      "ndc_label_name": "Bottle 500ml/Boston Round/Cap",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779597702",
      "ndc_label_name": "Bottle 500ml/Boston Round/Cap",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779584401",
      "ndc_label_name": "Bottle 8oz/Boston Round/Cap",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779826101",
      "ndc_label_name": "Bottle Amber Glass 33oz",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779729101",
      "ndc_label_name": "Bottle Amber Graduated 16oz",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779729102",
      "ndc_label_name": "Bottle Amber Graduated 16oz",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779729202",
      "ndc_label_name": "Bottle Amber Graduated 8oz",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779729201",
      "ndc_label_name": "Bottle Amber Graduated 8oz",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779591101",
      "ndc_label_name": "Bottle/White 6oz w/Twist Top",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779776401",
      "ndc_label_name": "Bottletop Dispenser",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840541604",
      "ndc_label_name": "Box Elder Pollen Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840541602",
      "ndc_label_name": "Box Elder Pollen Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42192010316",
      "ndc_label_name": "BP Cleansing Wash Emulsion 10-4 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70255002502",
      "ndc_label_name": "Braftovi Capsule 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70255002504",
      "ndc_label_name": "Braftovi Capsule 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70255002503",
      "ndc_label_name": "Braftovi Capsule 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70255002501",
      "ndc_label_name": "Braftovi Capsule 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840578205",
      "ndc_label_name": "Brazil Nut (Diagnostic) Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70914003330",
      "ndc_label_name": "Breathe Ease Large Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70914003320",
      "ndc_label_name": "Breathe Ease Medium Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70914003310",
      "ndc_label_name": "Breathe Ease Small Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462430100",
      "ndc_label_name": "BreatheRite Valved MDI Chamber Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462430220",
      "ndc_label_name": "BreatheRite Valved MDI Chamber Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462430120",
      "ndc_label_name": "BreatheRite Valved MDI Chamber Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08462430200",
      "ndc_label_name": "BreatheRite Valved MDI Chamber Device",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15137002126",
      "ndc_label_name": "Breeza for Oral Iodinated Cont Solution Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64896050901",
      "ndc_label_name": "Brekiya Solution Auto-Injector 1 MG/ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64896050902",
      "ndc_label_name": "Brekiya Solution Auto-Injector 1 MG/ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518202800",
      "ndc_label_name": "Breo Ellipta Aerosol Powder Breath Activated 100-25 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173085910",
      "ndc_label_name": "Breo Ellipta Aerosol Powder Breath Activated 100-25 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173085914",
      "ndc_label_name": "Breo Ellipta Aerosol Powder Breath Activated 100-25 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173085961",
      "ndc_label_name": "Breo Ellipta Aerosol Powder Breath Activated 100-25 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569666500",
      "ndc_label_name": "Breo Ellipta Aerosol Powder Breath Activated 200-25 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173088214",
      "ndc_label_name": "Breo Ellipta Aerosol Powder Breath Activated 200-25 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173088210",
      "ndc_label_name": "Breo Ellipta Aerosol Powder Breath Activated 200-25 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173091610",
      "ndc_label_name": "Breo Ellipta Aerosol Powder Breath Activated 50-25 MCG/INH Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75788011504",
      "ndc_label_name": "Brexafemme Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378750332",
      "ndc_label_name": "Breyna Aerosol 160-4.5 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378750232",
      "ndc_label_name": "Breyna Aerosol 80-4.5 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310461628",
      "ndc_label_name": "Breztri Aerosphere Aerosol 160-9-4.8 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310461612",
      "ndc_label_name": "Breztri Aerosphere Aerosol 160-9-4.8 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310461639",
      "ndc_label_name": "Breztri Aerosphere Aerosol 160-9-4.8 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462031684",
      "ndc_label_name": "Briellyn Tablet 0.4-35 MG-MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462031629",
      "ndc_label_name": "Briellyn TABLET 0.4-35 MG-MCG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452125002",
      "ndc_label_name": "Brij 30 Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927230100",
      "ndc_label_name": "Brij 35 WAX",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927230200",
      "ndc_label_name": "Brij 700 WAX",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927214300",
      "ndc_label_name": "Brij 93 Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452127002",
      "ndc_label_name": "Brij C20 Wax",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452128002",
      "ndc_label_name": "Brij S20 Wax",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00186077660",
      "ndc_label_name": "Brilinta Tablet 60 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00186077760",
      "ndc_label_name": "Brilinta Tablet 90 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00186077739",
      "ndc_label_name": "Brilinta Tablet 90 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00186077708",
      "ndc_label_name": "Brilinta Tablet 90 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154961808",
      "ndc_label_name": "Brilinta Tablet 90 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154961800",
      "ndc_label_name": "Brilinta Tablet 90 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610081541",
      "ndc_label_name": "Brilinta Tablet 90 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927466800",
      "ndc_label_name": "Brilliant Blue G POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452130001",
      "ndc_label_name": "Brilliant Green POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452130002",
      "ndc_label_name": "Brilliant Green POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927158300",
      "ndc_label_name": "Brilliant Green POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629961601",
      "ndc_label_name": "Brimonidine Tartrate Gel 0.33 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802007830",
      "ndc_label_name": "Brimonidine Tartrate Gel 0.33 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927474800",
      "ndc_label_name": "Brimonidine Tartrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927499200",
      "ndc_label_name": "Brimonidine Tartrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052066010",
      "ndc_label_name": "Brimonidine Tartrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927510500",
      "ndc_label_name": "Brimonidine Tartrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781717770",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332074910",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781717775",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82182032105",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781717785",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82182032110",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505057702",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332074905",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505057701",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82182032115",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505057703",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069056601",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332074915",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069056801",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069056701",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629879201",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.15 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314014410",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.15 % OPHTHALMIC",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505056402",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.15 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314014415",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.15 % OPHTHALMIC",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332066115",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.15 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314014405",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.15 % OPHTHALMIC",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505056403",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.15 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505056401",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.15 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82182077310",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.15 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332066105",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.15 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82182077315",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.15 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332066110",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.15 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82182077305",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.15 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071510",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208041110",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.2 % OPHTHALMIC",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314014305",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.2 % OPHTHALMIC",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071511",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090104600",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314014310",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.2 % OPHTHALMIC",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921018510",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208041115",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.2 % OPHTHALMIC",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071512",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314014315",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.2 % OPHTHALMIC",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921018515",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090636800",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208041105",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.2 % OPHTHALMIC",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069023201",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069023101",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069023301",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921018505",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832142515",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591242212",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505058902",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591242279",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781718675",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591242226",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781718670",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505058903",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332070605",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069065101",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462028132",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781718685",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505622502",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332070615",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832142505",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505622501",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069065201",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145016201",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832142510",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505058901",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069065301",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315033010",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505622500",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315033005",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921018810",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315033015",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145016301",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332070610",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462028169",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921018805",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921018815",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162209604",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162209602",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82182045510",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82182045505",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145016401",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82182045515",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162209607",
      "ndc_label_name": "Brimonidine Tartrate-Timolol Solution 0.2-0.5 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71558000130",
      "ndc_label_name": "Brinsupri Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71558000230",
      "ndc_label_name": "Brinsupri Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574401210",
      "ndc_label_name": "Brinzolamide Suspension 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574401215",
      "ndc_label_name": "Brinzolamide Suspension 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591212779",
      "ndc_label_name": "Brinzolamide Suspension 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591212712",
      "ndc_label_name": "Brinzolamide Suspension 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162220104",
      "ndc_label_name": "Brinzolamide Suspension 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208046410",
      "ndc_label_name": "Brinzolamide Suspension 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162220102",
      "ndc_label_name": "Brinzolamide Suspension 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682046410",
      "ndc_label_name": "Brinzolamide Suspension 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781601485",
      "ndc_label_name": "Brinzolamide Suspension 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781601470",
      "ndc_label_name": "Brinzolamide Suspension 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629879301",
      "ndc_label_name": "Brinzolamide Suspension 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208046415",
      "ndc_label_name": "Brinzolamide Suspension 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682046415",
      "ndc_label_name": "Brinzolamide Suspension 1 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50474087015",
      "ndc_label_name": "Briviact SOLUTION 10 MG/ML ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50474037066",
      "ndc_label_name": "Briviact TABLET 10 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50474077009",
      "ndc_label_name": "Briviact TABLET 100 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50474077066",
      "ndc_label_name": "Briviact TABLET 100 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50474047009",
      "ndc_label_name": "Briviact TABLET 25 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50474047066",
      "ndc_label_name": "Briviact TABLET 25 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50474057009",
      "ndc_label_name": "Briviact TABLET 50 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50474057066",
      "ndc_label_name": "Briviact TABLET 50 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50474067066",
      "ndc_label_name": "Briviact TABLET 75 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58284021691",
      "ndc_label_name": "Brixadi (Weekly) Solution Prefilled Syringe 16 MG/0.32ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58284021601",
      "ndc_label_name": "Brixadi (Weekly) Solution Prefilled Syringe 16 MG/0.32ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58284022491",
      "ndc_label_name": "Brixadi (Weekly) Solution Prefilled Syringe 24 MG/0.48ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58284022401",
      "ndc_label_name": "Brixadi (Weekly) Solution Prefilled Syringe 24 MG/0.48ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58284023201",
      "ndc_label_name": "Brixadi (Weekly) Solution Prefilled Syringe 32 MG/0.64ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58284023291",
      "ndc_label_name": "Brixadi (Weekly) Solution Prefilled Syringe 32 MG/0.64ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58284020801",
      "ndc_label_name": "Brixadi (Weekly) Solution Prefilled Syringe 8 MG/0.16ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58284022891",
      "ndc_label_name": "Brixadi Solution Prefilled Syringe 128 MG/0.36ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58284022801",
      "ndc_label_name": "Brixadi Solution Prefilled Syringe 128 MG/0.36ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58284026401",
      "ndc_label_name": "Brixadi Solution Prefilled Syringe 64 MG/0.18ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58284026491",
      "ndc_label_name": "Brixadi Solution Prefilled Syringe 64 MG/0.18ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58284029601",
      "ndc_label_name": "Brixadi Solution Prefilled Syringe 96 MG/0.27ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58284029691",
      "ndc_label_name": "Brixadi Solution Prefilled Syringe 96 MG/0.27ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779261309",
      "ndc_label_name": "Bromelain POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779261304",
      "ndc_label_name": "Bromelain POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779261305",
      "ndc_label_name": "Bromelain POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452130603",
      "ndc_label_name": "Bromelain POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552140806",
      "ndc_label_name": "Bromelain POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452130601",
      "ndc_label_name": "Bromelain POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779261308",
      "ndc_label_name": "Bromelain POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927326700",
      "ndc_label_name": "Bromelain POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452130602",
      "ndc_label_name": "Bromelain POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452130604",
      "ndc_label_name": "Bromelain Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552140804",
      "ndc_label_name": "Bromelain POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552140805",
      "ndc_label_name": "Bromelain POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69437060516",
      "ndc_label_name": "Bromfed DM Syrup 2-30-10 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69437060504",
      "ndc_label_name": "Bromfed DM Syrup 2-30-10 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927507700",
      "ndc_label_name": "Bromfenac Sodium",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180043601",
      "ndc_label_name": "Bromfenac Sodium (Once-Daily) Solution 0.09 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383024971",
      "ndc_label_name": "Bromfenac Sodium (Once-Daily) Solution 0.09 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332050817",
      "ndc_label_name": "Bromfenac Sodium (Once-Daily) Solution 0.09 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862078917",
      "ndc_label_name": "Bromfenac Sodium (Once-Daily) Solution 0.09 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266014201",
      "ndc_label_name": "Bromfenac Sodium (Once-Daily) Solution 0.09 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485064971",
      "ndc_label_name": "Bromfenac Sodium (Once-Daily) Solution 0.09 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144031010",
      "ndc_label_name": "Bromfenac Sodium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144031001",
      "ndc_label_name": "Bromfenac Sodium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052002105",
      "ndc_label_name": "Bromfenac Sodium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052002101",
      "ndc_label_name": "Bromfenac Sodium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452130401",
      "ndc_label_name": "Bromfenac Sodium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052002150",
      "ndc_label_name": "Bromfenac Sodium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180043302",
      "ndc_label_name": "Bromfenac Sodium Solution 0.07 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82260060203",
      "ndc_label_name": "Bromfenac Sodium Solution 0.07 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505100602",
      "ndc_label_name": "Bromfenac Sodium Solution 0.07 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332058303",
      "ndc_label_name": "Bromfenac Sodium Solution 0.07 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907009303",
      "ndc_label_name": "Bromfenac Sodium Solution 0.07 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180043401",
      "ndc_label_name": "Bromfenac Sodium Solution 0.075 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49708075541",
      "ndc_label_name": "Bromfenac Sodium Solution 0.075 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452130503",
      "ndc_label_name": "Bromhexine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452130501",
      "ndc_label_name": "Bromhexine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452130502",
      "ndc_label_name": "Bromhexine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927179300",
      "ndc_label_name": "Bromhexine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452130504",
      "ndc_label_name": "Bromhexine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378709693",
      "ndc_label_name": "Bromocriptine Mesylate CAPSULE 5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304015830",
      "ndc_label_name": "Bromocriptine Mesylate CAPSULE 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378709601",
      "ndc_label_name": "Bromocriptine Mesylate CAPSULE 5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304015801",
      "ndc_label_name": "Bromocriptine Mesylate CAPSULE 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382011001",
      "ndc_label_name": "Bromocriptine Mesylate Capsule 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382011006",
      "ndc_label_name": "Bromocriptine Mesylate CAPSULE 5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927227400",
      "ndc_label_name": "Bromocriptine Mesylate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954097810",
      "ndc_label_name": "Bromocriptine Mesylate Tablet 2.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304096230",
      "ndc_label_name": "Bromocriptine Mesylate TABLET 2.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574010601",
      "ndc_label_name": "Bromocriptine Mesylate TABLET 2.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574010603",
      "ndc_label_name": "Bromocriptine Mesylate TABLET 2.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687028611",
      "ndc_label_name": "Bromocriptine Mesylate Tablet 2.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954097820",
      "ndc_label_name": "Bromocriptine Mesylate Tablet 2.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781532501",
      "ndc_label_name": "Bromocriptine Mesylate TABLET 2.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781532531",
      "ndc_label_name": "Bromocriptine Mesylate TABLET 2.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304096201",
      "ndc_label_name": "Bromocriptine Mesylate TABLET 2.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687028621",
      "ndc_label_name": "Bromocriptine Mesylate Tablet 2.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452130901",
      "ndc_label_name": "Brompheniramine Maleate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452130905",
      "ndc_label_name": "Brompheniramine Maleate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452130903",
      "ndc_label_name": "Brompheniramine Maleate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991163401",
      "ndc_label_name": "Brompheniramine Maleate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991163403",
      "ndc_label_name": "Brompheniramine Maleate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991163402",
      "ndc_label_name": "Brompheniramine Maleate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927195000",
      "ndc_label_name": "Brompheniramine Maleate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452130904",
      "ndc_label_name": "Brompheniramine Maleate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62295301907",
      "ndc_label_name": "Brompheniramine Maleate SOLUTION 10 MG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69852088110",
      "ndc_label_name": "Brompheniramine Maleate Solution 10 MG/ML Intramuscular",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49708075441",
      "ndc_label_name": "BromSite Solution 0.075 % Ophthalmic",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27437005530",
      "ndc_label_name": "Brovana Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27437006030",
      "ndc_label_name": "Brovana Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63402091164",
      "ndc_label_name": "Brovana Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27437005501",
      "ndc_label_name": "Brovana Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27437005560",
      "ndc_label_name": "Brovana Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27437006060",
      "ndc_label_name": "Brovana Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27437005504",
      "ndc_label_name": "Brovana Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63402091101",
      "ndc_label_name": "Brovana Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63402091130",
      "ndc_label_name": "Brovana Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63402091104",
      "ndc_label_name": "Brovana Nebulization Solution 15 MCG/2ML Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840577805",
      "ndc_label_name": "Brown Shrimp (Diagnostic) Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72579001102",
      "ndc_label_name": "Brukinsa Capsule 80 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72579012201",
      "ndc_label_name": "Brukinsa Tablet 160 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59088023405",
      "ndc_label_name": "Bruselix Cream 3.88 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59088023305",
      "ndc_label_name": "Bruselix Gel 3.88 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24338001701",
      "ndc_label_name": "Brynovin Solution 25 MG/ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69263080501",
      "ndc_label_name": "BSP 0820 Kit 30 MG/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065080094",
      "ndc_label_name": "BSS Plus Solution Intraocular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065080050",
      "ndc_label_name": "BSS Plus Solution Intraocular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452128701",
      "ndc_label_name": "Bubble Gum Concentrate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452128703",
      "ndc_label_name": "Bubble Gum Concentrate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452128702",
      "ndc_label_name": "Bubble Gum Concentrate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927182000",
      "ndc_label_name": "Bubble Gum Concentrate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552070503",
      "ndc_label_name": "Bubble Gum Concentrate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927189800",
      "ndc_label_name": "Bubble Gum Concentrate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927223300",
      "ndc_label_name": "Bubble Gum Concentrate Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927462100",
      "ndc_label_name": "Bubble Gum Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991147602",
      "ndc_label_name": "Bubble Gum Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86067000002",
      "ndc_label_name": "Bubble Gum Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779298502",
      "ndc_label_name": "Bubble Gum Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779298501",
      "ndc_label_name": "Bubble Gum Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991147601",
      "ndc_label_name": "Bubble Gum Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467014880",
      "ndc_label_name": "Bubble Gum OS Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467014890",
      "ndc_label_name": "Bubble Gum OS Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467014885",
      "ndc_label_name": "Bubble Gum OS Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467014895",
      "ndc_label_name": "Bubble Gum OS Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467013390",
      "ndc_label_name": "Bubble Gum WS Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467013385",
      "ndc_label_name": "Bubble Gum WS Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467013380",
      "ndc_label_name": "Bubble Gum WS Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467013395",
      "ndc_label_name": "Bubble Gum WS Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779705401",
      "ndc_label_name": "Bubble Point Tester Kit/Wizard",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81279012360",
      "ndc_label_name": "Bucapsol Capsule 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81279012460",
      "ndc_label_name": "Bucapsol Capsule 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81279012260",
      "ndc_label_name": "Bucapsol Capsule 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378715501",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079002003",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714082901",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980025501",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574985510",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407059101",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162247301",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904731310",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079002001",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407012801",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862058001",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687059633",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687059632",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429026401",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382072001",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162077810",
      "ndc_label_name": "Budesonide CAPSULE DELAYED RELEASE PARTICLES 3 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629909301",
      "ndc_label_name": "Budesonide ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407036630",
      "ndc_label_name": "Budesonide ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162189803",
      "ndc_label_name": "Budesonide ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378450093",
      "ndc_label_name": "Budesonide ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591251030",
      "ndc_label_name": "Budesonide ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407082430",
      "ndc_label_name": "Budesonide ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682030930",
      "ndc_label_name": "Budesonide ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802062701",
      "ndc_label_name": "Budesonide Foam 2 MG Rectal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802062786",
      "ndc_label_name": "Budesonide Foam 2 MG Rectal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019800",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779276900",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10695012405",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309705",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779276903",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019804",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779276904",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019803",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129105",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991117903",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019805",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129101",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779276905",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309704",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129103",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019806",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592002701",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68981001701",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779276906",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552136503",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129102",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129104",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592002725",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129203",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552136505",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592002705",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309700",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592002710",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052027005",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991299703",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991117904",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129205",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309703",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991299704",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309706",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592002711",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129201",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129206",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129202",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991117905",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129204",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991299702",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552136501",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052027001",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927447500",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093681545",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115168774",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788729003",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487960101",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115168776",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093681573",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093681555",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093681519",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487960130",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781751587",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714001830",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714001805",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781751514",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090146700",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097031887",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980063803",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097031832",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335063149",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282064037",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788842903",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090659000",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097031853",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090717300",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097031886",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135082284",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282064038",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714001930",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093681673",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093681619",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093681655",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180098430",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487970101",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093681645",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115168976",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335063249",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781751687",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115168974",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788731403",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097031986",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487970130",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781751614",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687052483",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651058505",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090658600",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090712600",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097031953",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282064137",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714001905",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135082384",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282064138",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651058530",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180098405",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980063903",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687052479",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097031932",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097031987",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204001801",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282064238",
      "ndc_label_name": "Budesonide Suspension 1 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335063349",
      "ndc_label_name": "Budesonide Suspension 1 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093681773",
      "ndc_label_name": "Budesonide SUSPENSION 1 MG/2ML INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093681719",
      "ndc_label_name": "Budesonide SUSPENSION 1 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097032153",
      "ndc_label_name": "Budesonide Suspension 1 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282064237",
      "ndc_label_name": "Budesonide Suspension 1 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781751787",
      "ndc_label_name": "Budesonide SUSPENSION 1 MG/2ML INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781751714",
      "ndc_label_name": "Budesonide SUSPENSION 1 MG/2ML INHALATION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714002030",
      "ndc_label_name": "Budesonide Suspension 1 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714002005",
      "ndc_label_name": "Budesonide Suspension 1 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097032186",
      "ndc_label_name": "Budesonide Suspension 1 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097032132",
      "ndc_label_name": "Budesonide Suspension 1 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097032187",
      "ndc_label_name": "Budesonide SUSPENSION 1 MG/2ML Inhalation",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310737020",
      "ndc_label_name": "Budesonide-Formoterol Fumarate Aerosol 160-4.5 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518310700",
      "ndc_label_name": "Budesonide-Formoterol Fumarate Aerosol 160-4.5 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090632700",
      "ndc_label_name": "Budesonide-Formoterol Fumarate Aerosol 160-4.5 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310737220",
      "ndc_label_name": "Budesonide-Formoterol Fumarate Aerosol 80-4.5 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090638200",
      "ndc_label_name": "Budesonide-Formoterol Fumarate Aerosol 80-4.5 MCG/ACT Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927374600",
      "ndc_label_name": "Buflomedil HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409141204",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641600710",
      "ndc_label_name": "Bumetanide SOLUTION 0.25 MG/ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409141234",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641600701",
      "ndc_label_name": "Bumetanide SOLUTION 0.25 MG/ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409141210",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219057001",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409141240",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021032110",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641616110",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641628501",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641628401",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641616201",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641600801",
      "ndc_label_name": "Bumetanide SOLUTION 0.25 MG/ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462046940",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722036910",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860040641",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641616210",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219057004",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641628510",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641628410",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641600810",
      "ndc_label_name": "Bumetanide SOLUTION 0.25 MG/ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462046954",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860040504",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462047040",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722036932",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748032311",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722036831",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748032310",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641616101",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860040610",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205010207",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205010201",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748032301",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860040541",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205010107",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301008002",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021032104",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205010101",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748032302",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572004001",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722036832",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572004101",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219057201",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572004110",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219057210",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462047054",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572004010",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301008102",
      "ndc_label_name": "Bumetanide Solution 0.25 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14539070005",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832054011",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268013015",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756007911",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090566400",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185012801",
      "ndc_label_name": "Bumetanide TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185012805",
      "ndc_label_name": "Bumetanide TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799011901",
      "ndc_label_name": "Bumetanide TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547089610",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14539070001",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162219501",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672422301",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238148901",
      "ndc_label_name": "Bumetanide TABLET 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382052501",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571067901",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888001901",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268013011",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603029701",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714083101",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090630800",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090773600",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155090105",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904701604",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547089710",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904701661",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603029801",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714083201",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185012901",
      "ndc_label_name": "Bumetanide TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185012905",
      "ndc_label_name": "Bumetanide TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687038465",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268013115",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268013111",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714083202",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687038495",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799012002",
      "ndc_label_name": "Bumetanide TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904701606",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832054111",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001603",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672422401",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687038411",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090566602",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162219601",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353028809",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14539070101",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14539070105",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888002001",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687038401",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382052605",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382052601",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571067801",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756008011",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238149005",
      "ndc_label_name": "Bumetanide TABLET 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090613802",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155090101",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001602",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804011990",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238149001",
      "ndc_label_name": "Bumetanide TABLET 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799012001",
      "ndc_label_name": "Bumetanide TABLET 1 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603029802",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547089750",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687038425",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090634502",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001601",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335267001",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756008051",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335292001",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001604",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162219605",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571067701",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832064211",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185013005",
      "ndc_label_name": "Bumetanide TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14539070201",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090785400",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090735000",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14539070205",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185013001",
      "ndc_label_name": "Bumetanide TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090566300",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714083302",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720230",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799012102",
      "ndc_label_name": "Bumetanide TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238149105",
      "ndc_label_name": "Bumetanide TABLET 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603029902",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238149101",
      "ndc_label_name": "Bumetanide TABLET 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832054211",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687053501",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353029216",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714083301",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547089850",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687053511",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687053565",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335270503",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155090201",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335299801",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382052701",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155090205",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382052705",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799012101",
      "ndc_label_name": "Bumetanide TABLET 2 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162219701",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090506400",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547089810",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090630400",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888002101",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268013215",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518267800",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756008111",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268013211",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162219705",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756008151",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603029901",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672422501",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518319100",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "30698063001",
      "ndc_label_name": "Bumex TABLET 0.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00095300001",
      "ndc_label_name": "Bupap Tablet 50-300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75987007009",
      "ndc_label_name": "Buphenyl POWDER 3 GM/TSP ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75987006008",
      "ndc_label_name": "Buphenyl TABLET 500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81371504003",
      "ndc_label_name": "Bupivacaine HCl (Bulk) Solution 4760 MG/119ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143933010",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143933310",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409115902",
      "ndc_label_name": "Bupivacaine HCl (PF) SOLUTION 0.25 % INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722027530",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143933001",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409115910",
      "ndc_label_name": "Bupivacaine HCl (PF) SOLUTION 0.25 % INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722027532",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409115901",
      "ndc_label_name": "Bupivacaine HCl (PF) SOLUTION 0.25 % INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143933301",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150016710",
      "ndc_label_name": "Bupivacaine HCl (PF) SOLUTION 0.25 % INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722027533",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722027531",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409115919",
      "ndc_label_name": "Bupivacaine HCl (PF) SOLUTION 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288072111",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603032725",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409115918",
      "ndc_label_name": "Bupivacaine HCl (PF) SOLUTION 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409115909",
      "ndc_label_name": "Bupivacaine HCl (PF) SOLUTION 0.25 % INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603041525",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594011501",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288072232",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594011401",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603032710",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150016830",
      "ndc_label_name": "Bupivacaine HCl (PF) SOLUTION 0.25 % INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722027510",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603041510",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722027534",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594011402",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420001810",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143933401",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409116218",
      "ndc_label_name": "Bupivacaine HCl (PF) SOLUTION 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143933101",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143933410",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594011701",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143933110",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722027610",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409116209",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409116202",
      "ndc_label_name": "Bupivacaine HCl (PF) SOLUTION 0.5 % INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722027632",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409116201",
      "ndc_label_name": "Bupivacaine HCl (PF) SOLUTION 0.5 % INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409116210",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603050625",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603050610",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288072411",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594011702",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409116219",
      "ndc_label_name": "Bupivacaine HCl (PF) SOLUTION 0.5 % INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722027633",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722027634",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722027630",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603060201",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518236000",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150017030",
      "ndc_label_name": "Bupivacaine HCl (PF) SOLUTION 0.5 % INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594011801",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722027631",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603060225",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518236001",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150016910",
      "ndc_label_name": "Bupivacaine HCl (PF) SOLUTION 0.5 % INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288072532",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409116519",
      "ndc_label_name": "Bupivacaine HCl (PF) SOLUTION 0.75 % INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722027730",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.75 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143933210",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.75 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722027732",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.75 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143933510",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.75 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143933501",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.75 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143933201",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.75 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409116501",
      "ndc_label_name": "Bupivacaine HCl (PF) SOLUTION 0.75 % INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722027710",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.75 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722027734",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.75 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409116502",
      "ndc_label_name": "Bupivacaine HCl (PF) SOLUTION 0.75 % INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594012001",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.75 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594012002",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.75 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594012101",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.75 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409116518",
      "ndc_label_name": "Bupivacaine HCl (PF) SOLUTION 0.75 % INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603080001",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.75 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288072711",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.75 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603070025",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.75 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722027731",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.75 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603080025",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.75 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722027733",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.75 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150017110",
      "ndc_label_name": "Bupivacaine HCl (PF) SOLUTION 0.75 % INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288072832",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.75 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150017230",
      "ndc_label_name": "Bupivacaine HCl (PF) SOLUTION 0.75 % INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603070010",
      "ndc_label_name": "Bupivacaine HCl (PF) Solution 0.75 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779052409",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779052405",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455698806",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455698802",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455698801",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144014110",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455698803",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927235800",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991201402",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779052408",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452131303",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455698805",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455698804",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452131301",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779052401",
      "ndc_label_name": "Bupivacaine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60966012704",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991201403",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288120905",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452131304",
      "ndc_label_name": "Bupivacaine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779052403",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15455698807",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452131302",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779052404",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991201406",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991201405",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60966042701",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552045605",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307006005",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452131305",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552045601",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552045607",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991201407",
      "ndc_label_name": "Bupivacaine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552045604",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991201401",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288120910",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998404",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60966022703",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552045602",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991201404",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75840010601",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307006011",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998401",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69589000201",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998405",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998402",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60966032702",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393020805",
      "ndc_label_name": "Bupivacaine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393020808",
      "ndc_label_name": "Bupivacaine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393020807",
      "ndc_label_name": "Bupivacaine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307006015",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393020811",
      "ndc_label_name": "Bupivacaine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092998403",
      "ndc_label_name": "Bupivacaine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393020810",
      "ndc_label_name": "Bupivacaine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374097005",
      "ndc_label_name": "Bupivacaine HCl Solution 0.125 % Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143932810",
      "ndc_label_name": "Bupivacaine HCl Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603027901",
      "ndc_label_name": "BUPivacaine HCl Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143932801",
      "ndc_label_name": "Bupivacaine HCl Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409116001",
      "ndc_label_name": "Bupivacaine HCl SOLUTION 0.25 % INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288072352",
      "ndc_label_name": "Bupivacaine HCl Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069075210",
      "ndc_label_name": "BUPivacaine HCl Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409116018",
      "ndc_label_name": "Bupivacaine HCl SOLUTION 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150024950",
      "ndc_label_name": "Bupivacaine HCl SOLUTION 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069075225",
      "ndc_label_name": "BUPivacaine HCl Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81483000300",
      "ndc_label_name": "BUPivacaine HCl Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069075201",
      "ndc_label_name": "BUPivacaine HCl Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594011601",
      "ndc_label_name": "Bupivacaine HCl Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603027925",
      "ndc_label_name": "BUPivacaine HCl Solution 0.25 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143932901",
      "ndc_label_name": "Bupivacaine HCl Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069075301",
      "ndc_label_name": "BUPivacaine HCl Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150025050",
      "ndc_label_name": "Bupivacaine HCl SOLUTION 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143932910",
      "ndc_label_name": "Bupivacaine HCl Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409116318",
      "ndc_label_name": "Bupivacaine HCl SOLUTION 0.5 % INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090451600",
      "ndc_label_name": "Bupivacaine HCl Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594011901",
      "ndc_label_name": "Bupivacaine HCl Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81483000400",
      "ndc_label_name": "BUPivacaine HCl Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288072652",
      "ndc_label_name": "Bupivacaine HCl Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603028701",
      "ndc_label_name": "BUPivacaine HCl Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069075310",
      "ndc_label_name": "BUPivacaine HCl Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409116301",
      "ndc_label_name": "Bupivacaine HCl SOLUTION 0.5 % INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603028725",
      "ndc_label_name": "BUPivacaine HCl Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069075325",
      "ndc_label_name": "BUPivacaine HCl Solution 0.5 % Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374097050",
      "ndc_label_name": "Bupivacaine HCl Solution Prefilled Syringe 0.125 % (50 ML) Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409361301",
      "ndc_label_name": "Bupivacaine Spinal SOLUTION 0.75-8.25 % Intrathecal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409361311",
      "ndc_label_name": "Bupivacaine Spinal Solution 0.75-8.25 % Intrathecal",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072001",
      "ndc_label_name": "Bupivilog KIT 40 & 0.5 MG/ML-% INJECTION",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425035301",
      "ndc_label_name": "Bupivilog Kit 40 & 0.5 MG/ML-% Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12496075705",
      "ndc_label_name": "Buprenex Solution 0.3 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12496075701",
      "ndc_label_name": "Buprenex Solution 0.3 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779088800",
      "ndc_label_name": "Buprenorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779088809",
      "ndc_label_name": "Buprenorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552076506",
      "ndc_label_name": "Buprenorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452825301",
      "ndc_label_name": "Buprenorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779088801",
      "ndc_label_name": "Buprenorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779088803",
      "ndc_label_name": "Buprenorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991158304",
      "ndc_label_name": "Buprenorphine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779088805",
      "ndc_label_name": "Buprenorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991158303",
      "ndc_label_name": "Buprenorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991158302",
      "ndc_label_name": "Buprenorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552076509",
      "ndc_label_name": "Buprenorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452825302",
      "ndc_label_name": "Buprenorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779088806",
      "ndc_label_name": "Buprenorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452825303",
      "ndc_label_name": "Buprenorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393011503",
      "ndc_label_name": "Buprenorphine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552076501",
      "ndc_label_name": "Buprenorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991158306",
      "ndc_label_name": "Buprenorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393011507",
      "ndc_label_name": "Buprenorphine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393011508",
      "ndc_label_name": "Buprenorphine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991158301",
      "ndc_label_name": "Buprenorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927101200",
      "ndc_label_name": "Buprenorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452825304",
      "ndc_label_name": "Buprenorphine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991158308",
      "ndc_label_name": "Buprenorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552076503",
      "ndc_label_name": "Buprenorphine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991158307",
      "ndc_label_name": "Buprenorphine HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393011504",
      "ndc_label_name": "Buprenorphine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393011505",
      "ndc_label_name": "Buprenorphine HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409201232",
      "ndc_label_name": "Buprenorphine HCl SOLUTION 0.3 MG/ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409201203",
      "ndc_label_name": "Buprenorphine HCl SOLUTION 0.3 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023017905",
      "ndc_label_name": "Buprenorphine HCl SOLUTION 0.3 MG/ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143924601",
      "ndc_label_name": "Buprenorphine HCl Solution 0.3 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069002701",
      "ndc_label_name": "Buprenorphine HCl Solution 0.3 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143924605",
      "ndc_label_name": "Buprenorphine HCl Solution 0.3 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069002705",
      "ndc_label_name": "Buprenorphine HCl Solution 0.3 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023017901",
      "ndc_label_name": "Buprenorphine HCl SOLUTION 0.3 MG/ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228315603",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 2 MG SUBLINGUAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162134403",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700030230",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629712502",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518221700",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054017613",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 2 MG SUBLINGUAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268012811",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121101930",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42858050103",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222602",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335095002",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904715404",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222600",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335095001",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629712501",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383092493",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268012815",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335095003",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222603",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687048111",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518222601",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189057960",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629947501",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687048121",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189058060",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189058090",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888018230",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756045983",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 2 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090157100",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904715504",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518162500",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090580500",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228315303",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 8 MG SUBLINGUAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42858050203",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054017713",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 8 MG SUBLINGUAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687049211",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090292400",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756046083",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335115401",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687049221",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268012915",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090755900",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121203830",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629712602",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518201400",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335116303",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189058260",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518201401",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383093093",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268012911",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518221800",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335116302",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335116301",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888018330",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162134503",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629712601",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335115402",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335115403",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598058101",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378876893",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781035803",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52427071211",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742036530",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378876816",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52427071203",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598058130",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781035811",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742036501",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598057901",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742039701",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742039730",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52427069211",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378876516",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781035503",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378876593",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781035511",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598057930",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52427069203",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378876693",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781035611",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378876616",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52427069403",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598058001",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598058030",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781035603",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742039830",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742039801",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52427069411",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378876716",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598058201",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378876793",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742036401",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781035703",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742036430",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598058230",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781035711",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52427069803",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52427069811",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054018813",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 2-0.5 MG SUBLINGUAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121101830",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268014415",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 2-0.5 MG SUBLINGUAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335129601",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228315403",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406800503",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904700906",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335151401",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729054910",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42858060103",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162041603",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 2-0.5 MG SUBLINGUAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429058630",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268014411",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 2-0.5 MG SUBLINGUAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62175045232",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756096983",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629948201",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383029493",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518100700",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700090130",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162134603",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687062611",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687062665",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729055010",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42858060203",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904701006",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054018913",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 8-2 MG SUBLINGUAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121203630",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687063711",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406802003",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228315503",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268014515",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268014511",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756097083",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383028793",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335172501",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62175045832",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687063765",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429058730",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335185801",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518338900",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162041503",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 8-2 MG SUBLINGUAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629948301",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162134703",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335172502",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518231100",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335137801",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518312900",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335185802",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335282801",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238120302",
      "ndc_label_name": "Buprenorphine Patch Weekly 10 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858049340",
      "ndc_label_name": "Buprenorphine Patch Weekly 10 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093365721",
      "ndc_label_name": "Buprenorphine Patch Weekly 10 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093365740",
      "ndc_label_name": "Buprenorphine Patch Weekly 10 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781040704",
      "ndc_label_name": "Buprenorphine Patch Weekly 10 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742037401",
      "ndc_label_name": "Buprenorphine Patch Weekly 10 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742037404",
      "ndc_label_name": "Buprenorphine Patch Weekly 10 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505707705",
      "ndc_label_name": "Buprenorphine Patch Weekly 10 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858058640",
      "ndc_label_name": "Buprenorphine Patch Weekly 15 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093365821",
      "ndc_label_name": "Buprenorphine Patch Weekly 15 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742037504",
      "ndc_label_name": "Buprenorphine Patch Weekly 15 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093365840",
      "ndc_label_name": "Buprenorphine Patch Weekly 15 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781041904",
      "ndc_label_name": "Buprenorphine Patch Weekly 15 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742037501",
      "ndc_label_name": "Buprenorphine Patch Weekly 15 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238120402",
      "ndc_label_name": "Buprenorphine Patch Weekly 15 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505707805",
      "ndc_label_name": "Buprenorphine Patch Weekly 15 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238120502",
      "ndc_label_name": "Buprenorphine Patch Weekly 20 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093365940",
      "ndc_label_name": "Buprenorphine Patch Weekly 20 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093365921",
      "ndc_label_name": "Buprenorphine Patch Weekly 20 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781040804",
      "ndc_label_name": "Buprenorphine Patch Weekly 20 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742037601",
      "ndc_label_name": "Buprenorphine Patch Weekly 20 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505707905",
      "ndc_label_name": "Buprenorphine Patch Weekly 20 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858083940",
      "ndc_label_name": "Buprenorphine Patch Weekly 20 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742037604",
      "ndc_label_name": "Buprenorphine Patch Weekly 20 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238120202",
      "ndc_label_name": "Buprenorphine Patch Weekly 5 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742037204",
      "ndc_label_name": "Buprenorphine Patch Weekly 5 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093365621",
      "ndc_label_name": "Buprenorphine Patch Weekly 5 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858075040",
      "ndc_label_name": "Buprenorphine Patch Weekly 5 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093365640",
      "ndc_label_name": "Buprenorphine Patch Weekly 5 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742037201",
      "ndc_label_name": "Buprenorphine Patch Weekly 5 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781040604",
      "ndc_label_name": "Buprenorphine Patch Weekly 5 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505707505",
      "ndc_label_name": "Buprenorphine Patch Weekly 5 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238150502",
      "ndc_label_name": "Buprenorphine Patch Weekly 7.5 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742037301",
      "ndc_label_name": "Buprenorphine Patch Weekly 7.5 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858035340",
      "ndc_label_name": "Buprenorphine Patch Weekly 7.5 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505707605",
      "ndc_label_name": "Buprenorphine Patch Weekly 7.5 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093323921",
      "ndc_label_name": "Buprenorphine Patch Weekly 7.5 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093323940",
      "ndc_label_name": "Buprenorphine Patch Weekly 7.5 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742037304",
      "ndc_label_name": "Buprenorphine Patch Weekly 7.5 MCG/HR Transdermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591354376",
      "ndc_label_name": "BuPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591354360",
      "ndc_label_name": "BuPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090510100",
      "ndc_label_name": "buPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598086360",
      "ndc_label_name": "BuPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090732200",
      "ndc_label_name": "buPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090115001",
      "ndc_label_name": "BuPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090115000",
      "ndc_label_name": "BuPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041360",
      "ndc_label_name": "buPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090510101",
      "ndc_label_name": "buPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090732201",
      "ndc_label_name": "buPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722006605",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185041005",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722006601",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041001",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185041001",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591354060",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591354005",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353053882",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353053816",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722006660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806042401",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353073582",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185041060",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547028850",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335073688",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547028810",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335073686",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041005",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353073518",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090713000",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904727061",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228017405",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002150903",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090674300",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090282000",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598075101",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598075105",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090734900",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041060",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228017460",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919003660",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228017401",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651084601",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090258400",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090296400",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788717009",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806042460",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651084605",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788781909",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187095260",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187095214",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959080560",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002150900",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788781906",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598075160",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205038730",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436005801",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788717003",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189005730",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002150906",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187017660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436005802",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335073613",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205038760",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518264100",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097087707",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084069701",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788717006",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187095230",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789015860",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084069711",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771017405",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629319603",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518305800",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788781903",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189005760",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335186601",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771017460",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353064060",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720091",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720081",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185041505",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185041560",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185041552",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041505",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185041501",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547028910",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591354125",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722006705",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720090",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720060",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720030",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041560",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591354105",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335073713",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904658561",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041501",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806042501",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720085",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720092",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547028950",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904721461",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090307800",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722006701",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063074430",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353054680",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806042505",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591354160",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324902",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722006760",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324900",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353054660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353064030",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598075205",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086100",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904746561",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090345300",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063091330",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324903",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353064080",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335073786",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086101",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086201",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353054630",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090385400",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090385401",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090687101",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598075201",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086200",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086102",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635301",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598075260",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090385402",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090687100",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651084701",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335073788",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635300",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086202",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187072630",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086103",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090385403",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090687103",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187005260",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635302",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635303",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090086203",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544029930",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090324901",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635400",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090742202",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544029980",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228017560",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090742201",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228017501",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788876902",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090687102",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090742200",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090742203",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780702",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002134506",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959080660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002134503",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788876903",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090687200",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228017505",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090742300",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780709",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700089530",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919013630",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700089560",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335013501",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959080630",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651084705",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084070895",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934015190",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919003830",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187005278",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919013660",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335013507",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002134500",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919006360",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780703",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934079130",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187005230",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187072690",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187072660",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335061201",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629847301",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544029953",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780706",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610057060",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205055060",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780701",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788876901",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071012260",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544029960",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436005922",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205055030",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084070825",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335000601",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934015696",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934015130",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788780708",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071012230",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934079160",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610057660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788876908",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335000606",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205056560",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205056530",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436005901",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788876906",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335000602",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610057680",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436005902",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335183703",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335000603",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335000604",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934015160",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788876909",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335000607",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335000605",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335013504",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189034930",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335245701",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335013503",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335013506",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518307900",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335245703",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335170201",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610057630",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518331800",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610057080",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335170203",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162152905",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934015196",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189034960",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934079190",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335013502",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335013505",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335183701",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771017505",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771017560",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185111160",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722006860",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335073886",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591354260",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353018983",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598075360",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722006801",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041160",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353090083",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806042660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788779303",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788728309",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228017660",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651084801",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228017601",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335073888",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547029010",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187017860",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771017660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788779309",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788779301",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788728301",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002153603",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651084860",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788779302",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187056660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788728302",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788779306",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788728303",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788728306",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788728308",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788779308",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436006001",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610058283",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591333105",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904750561",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527241532",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904750504",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591333119",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781552810",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904708461",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527241546",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904708404",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135070305",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527241541",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979010107",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781552831",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291018250",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571086209",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135070330",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10370010103",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090711002",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591333130",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090404902",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571086212",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090404900",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729044316",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135070390",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10370010150",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090711300",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571086203",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090678900",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291018230",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090474700",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806034809",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729044310",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571086250",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020605",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090137202",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228014405",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806034805",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090474702",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806034830",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729044315",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979010106",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002149503",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090617301",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228014430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090516302",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598065505",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979010102",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041405",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071090",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090711301",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228014490",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063038790",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090711000",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090313900",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041409",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598065530",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687078201",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090771200",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268013311",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598065590",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090711200",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090617300",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090290400",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090617302",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919055872",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817034590",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268013313",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090137200",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090771100",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268014011",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090516300",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090710900",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919058930",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187071330",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687031201",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090137201",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090771102",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002149500",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090516301",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268014013",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919058960",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187076630",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687031211",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090404901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020630",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687078211",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090711302",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020690",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629213701",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679010205",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187012430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090474701",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002149509",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919006960",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090771101",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071030",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679010201",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180031906",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304072390",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090711001",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071230",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187071390",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700084930",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071290",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180031902",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788775608",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679010202",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817034550",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919067430",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001051903",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187012490",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919055890",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382035306",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788782009",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001061303",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071050",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187076690",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001051904",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001051905",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135087530",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788401009",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518236502",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071202306",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071250",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304072305",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001061305",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788782001",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180031909",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788775606",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382035316",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304072330",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788782003",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788747901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097007112",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788778601",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788775609",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205096730",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788401001",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629213601",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367028809",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788747908",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70010078409",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788778608",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788778606",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789037790",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788401006",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629847401",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69680015790",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788778603",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518263701",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788782006",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788778609",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425030003",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788747906",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001061304",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70010078403",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69680015792",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934072430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788782008",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097087502",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425046103",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788747909",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382035305",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436001006",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70010078405",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205004590",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518263700",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097087512",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518245802",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788775601",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788401003",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518245801",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162152605",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335237801",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934072490",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436001004",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189013490",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367028805",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788747903",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205096790",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771014490",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610054360",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205004530",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518085900",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425046101",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436001002",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788775603",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162121803",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205096755",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189013472",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097087505",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335246901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425030001",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205007690",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518205100",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162121805",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009005105",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189025290",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518245800",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789030190",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301002404",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205039490",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518245803",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162152603",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205029130",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771014405",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205029190",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425030002",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610034660",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050490",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301002403",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789012090",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771014430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804008090",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335246903",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425046102",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008008230",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301002402",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301002401",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781552910",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527243046",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598065605",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527243032",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135070490",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527243041",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135070405",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571086309",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781552931",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904657304",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963014205",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135070430",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063038890",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904746904",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729044410",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729044415",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979010202",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041630",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090105901",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10370010203",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963014290",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571086303",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729044416",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979010206",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806034905",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090105900",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090474901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10370010250",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090533401",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571086350",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041609",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291018330",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090696200",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090272100",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817034690",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979010207",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268014111",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806034909",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228014505",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291018350",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228014530",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090533400",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002150803",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090272101",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700014330",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806041605",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817034650",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598065630",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020730",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090625800",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700082090",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090474900",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700014360",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090524500",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135087630",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45963014230",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020790",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090696100",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629213901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090625801",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700082030",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090733401",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629331601",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090524501",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071190",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090696101",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180032009",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090733400",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071150",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090760200",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001032105",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268013413",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071350",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090733500",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712106",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228014590",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187081930",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700014390",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084025221",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687079311",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187052130",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268013411",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712109",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020705",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304072430",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071130",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788750901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687079321",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304072490",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268014115",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788799203",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071330",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629331602",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657071390",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788799208",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629331604",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629331603",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304072405",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788799206",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187017930",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629331605",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001052003",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788827208",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001032103",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001032104",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180032002",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788858908",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629213801",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084025211",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001052005",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788853701",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788750903",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001052004",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788750909",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788881503",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629847501",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180032006",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001061404",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788867703",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788750906",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001061405",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788827206",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097007212",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629847601",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712101",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788786303",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70010078503",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788750908",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788858903",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788853709",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70010078509",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739013233",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712108",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788827203",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518277200",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788786301",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367028905",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788858909",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436001102",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001061403",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788786306",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097087602",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518277202",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788786308",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436001106",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788867701",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518233200",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071131100",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788786309",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367028909",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335082401",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788799209",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934080430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788867706",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934075890",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382035406",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788799201",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205096830",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335249901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788827201",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205096890",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788881508",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205046590",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712103",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788827209",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335068701",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189012430",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788858901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335082403",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70010078505",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205096855",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788853703",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788853708",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335231203",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771014590",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788881509",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425046802",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205024830",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335121401",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788853706",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788867708",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162121903",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425046801",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69680015892",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788881501",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189012472",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610013130",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788858906",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788881506",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162121905",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009005205",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518089700",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097087612",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425053902",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162152703",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788867709",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436001104",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162152705",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301002502",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518122900",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610013160",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771014530",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789011290",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205046530",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189053930",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301002503",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425053903",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518277201",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771014505",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425053901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518277203",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335033101",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335082405",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335111403",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335231201",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162127809",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189053990",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282048130",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425046803",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804001330",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301002501",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301002504",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979024806",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 450 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781063730",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 450 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679083001",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 450 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927482600",
      "ndc_label_name": "BuPROPion HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991281903",
      "ndc_label_name": "BuPROPion HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991281902",
      "ndc_label_name": "BuPROPion HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10695017070",
      "ndc_label_name": "buPROPion HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991281904",
      "ndc_label_name": "BuPROPion HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452825505",
      "ndc_label_name": "BuPROPion HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452825503",
      "ndc_label_name": "BuPROPion HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452825504",
      "ndc_label_name": "BuPROPion HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393021008",
      "ndc_label_name": "buPROPion HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393021010",
      "ndc_label_name": "buPROPion HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052039101",
      "ndc_label_name": "BuPROPion HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991281901",
      "ndc_label_name": "BuPROPion HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393021017",
      "ndc_label_name": "buPROPion HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927335800",
      "ndc_label_name": "BuPROPion HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452825506",
      "ndc_label_name": "BuPROPion HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452825507",
      "ndc_label_name": "BuPROPion HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052039150",
      "ndc_label_name": "BuPROPion HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052039102",
      "ndc_label_name": "buPROPion HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393021013",
      "ndc_label_name": "buPROPion HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393021011",
      "ndc_label_name": "buPROPion HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393021007",
      "ndc_label_name": "buPROPion HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052039110",
      "ndc_label_name": "buPROPion HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155019201",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720430",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720460",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904663661",
      "ndc_label_name": "BuPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057583",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268014311",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904753060",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689012001",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353076753",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353076760",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335018202",
      "ndc_label_name": "BuPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090751103",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090078503",
      "ndc_label_name": "BuPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651087501",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063099430",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090751100",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353076783",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353076770",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353076780",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959065502",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090186900",
      "ndc_label_name": "BuPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687035111",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090078500",
      "ndc_label_name": "BuPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959065540",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353076792",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002141700",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436910102",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002141706",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090186903",
      "ndc_label_name": "BuPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544089753",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959065590",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429074701",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268014315",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002141703",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505015701",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700077930",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959065500",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544089760",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135072490",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687035101",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959065530",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760078130",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267061430",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001030900",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788731903",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544089780",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788731901",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980020201",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959065560",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788798803",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610016483",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788798806",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788731906",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544089783",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332012731",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788731908",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788731909",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788798809",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335269001",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189045730",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335287501",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335018201",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007090",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518158400",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162240101",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007030",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162209701",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518158401",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804012330",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610070880",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789054490",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904663561",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155019101",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689011901",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057453",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720330",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057470",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720360",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057494",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904752960",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518293400",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356073530",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429074601",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057488",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268014211",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959089860",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002144700",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063088030",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335286701",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063088060",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980020101",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919003760",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335079107",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651087401",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002144703",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268014215",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610037253",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353057480",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610086660",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804012730",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610077480",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505015801",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610086680",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002144706",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610037270",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687034001",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162240001",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135072390",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610089980",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518156600",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610089953",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610037294",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610077453",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687034011",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610077470",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610089960",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610086670",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610037280",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332011831",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610038494",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001030800",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610077494",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610038480",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610086653",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162209801",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552082102",
      "ndc_label_name": "BusPIRone HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452131001",
      "ndc_label_name": "BusPIRone HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452131004",
      "ndc_label_name": "BusPIRone HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927339900",
      "ndc_label_name": "BusPIRone HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284502",
      "ndc_label_name": "BusPIRone HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452131003",
      "ndc_label_name": "BusPIRone HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452131002",
      "ndc_label_name": "BusPIRone HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452131005",
      "ndc_label_name": "BusPIRone HCl Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552082103",
      "ndc_label_name": "BusPIRone HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284501",
      "ndc_label_name": "BusPIRone HCl POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093005405",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093005401",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720730",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155002405",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904712161",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720790",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788005905",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720760",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378115001",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378115005",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689090705",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024501",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689090701",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788005901",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353061070",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729020216",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729020201",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063078590",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353006060",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008401",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008405",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806066301",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090418200",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155002401",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353006053",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353006070",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211001",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353006080",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353061060",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806066305",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090534701",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024505",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999081200",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211000",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211004",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353061053",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353061080",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090277300",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090664901",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543074207",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090418201",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211003",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090418203",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090326001",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353061092",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090326004",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187090460",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353006092",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090576200",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090316800",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090576203",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090418205",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090326000",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090664900",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382018105",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211005",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067690",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090418204",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407041505",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090576205",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090326003",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090664903",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788808603",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020205",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919060030",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090576204",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700052690",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919060090",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090326005",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090664905",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788808606",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700083730",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788701703",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090671900",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687081211",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629241001",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090576201",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079098601",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117004101",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700083790",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518068000",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687081201",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919060060",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380074206",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090664904",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079098620",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584009250",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039101",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518153000",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380074207",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187090490",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267052820",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407041501",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020201",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518203100",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267052890",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335975804",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788701701",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788788503",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382018101",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959067660",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039105",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335000702",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788788506",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610025780",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788701706",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788892906",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788701709",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629241101",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187090430",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335975801",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788788509",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030253",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788788501",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610020880",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584009210",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380074208",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117004102",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610020853",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788892903",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610059692",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788808601",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030270",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518203101",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267052845",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518327900",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610028180",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518153001",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610095353",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788892909",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610059670",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518203102",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788808609",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335167302",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030292",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335975803",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610095380",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238111701",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610096253",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934018490",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788892901",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335975802",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610059660",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610025753",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189044860",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030260",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189017590",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335000701",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335975806",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335975805",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610095370",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610025760",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014001",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610096260",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189020082",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610028153",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610020860",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610059653",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006401",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030280",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610028160",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189044830",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834026801",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610059680",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610095360",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610095392",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804010430",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610097453",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189017530",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189044890",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804010460",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610096280",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610097480",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610097492",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834026805",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610097430",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771023601",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162192501",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771023605",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610097460",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789018190",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162192505",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189044882",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006405",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008002930",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720860",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378116505",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155002506",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093100305",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788006001",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008501",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093100301",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689092101",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720890",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378116580",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155002508",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904689961",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155002501",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353060760",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720830",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300047705",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729020312",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378116591",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689092106",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729020301",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689092105",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353060780",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024605",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300047716",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024618",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788006005",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806066401",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300047701",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024601",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090697101",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024616",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806066405",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008505",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155002505",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079096001",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211103",
      "ndc_label_name": "BusPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543074318",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760054860",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300047718",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090716101",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211101",
      "ndc_label_name": "BusPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353060730",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407041660",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090465701",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090465703",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187040290",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090716103",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090729303",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090618801",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090588601",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959071390",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090588603",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090729301",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788787509",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090729300",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380074318",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268013515",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090618803",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700080360",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090697103",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959071345",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788976606",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020305",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788976601",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700086960",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959071300",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687082311",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268013511",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039205",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518309100",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700086990",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584009310",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629241201",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959071330",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380074303",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079096020",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919057972",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205028090",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919057960",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518068103",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629241301",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959071360",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788796806",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020360",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382018205",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335098503",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187040230",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335175204",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788746206",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039201",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788976603",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407041605",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788787501",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335160503",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788787503",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834026960",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788746209",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919057930",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117004204",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687082301",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788787506",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335257603",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788868103",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117004202",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788796809",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919057990",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584009350",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238111801",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788796803",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335257604",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788868106",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518297700",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788868101",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382018201",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518266000",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518298700",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238111806",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610020660",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788868109",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335027201",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117004203",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788796801",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335175201",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335027206",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518038000",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189023560",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117004201",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610020630",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518040100",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788976609",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610029960",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610029160",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205028030",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771023760",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584009306",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610097560",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518297701",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610018353",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610034453",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789033260",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335175203",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610018360",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518105001",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425038701",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518298701",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610029953",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006501",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425038703",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335206004",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610029992",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335027202",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610064030",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518309101",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610064060",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834026901",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610064080",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610029930",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189062030",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335027203",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189062090",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335027204",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006505",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189023590",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834026905",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162192601",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425030301",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335027205",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189023530",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610029980",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014101",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610064092",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006560",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162192605",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425030302",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189062060",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425030303",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771023705",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425038702",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093520005",
      "ndc_label_name": "BusPIRone HCl TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378117591",
      "ndc_label_name": "BusPIRone HCl TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093520006",
      "ndc_label_name": "BusPIRone HCl TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090774200",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155009705",
      "ndc_label_name": "BusPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788006160",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300047816",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729028912",
      "ndc_label_name": "BusPIRone HCl TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079099401",
      "ndc_label_name": "BusPIRone HCl TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788006105",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291017750",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039360",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155009706",
      "ndc_label_name": "BusPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008605",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008660",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689093306",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629241401",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024705",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959083460",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518198101",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300047805",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079099420",
      "ndc_label_name": "BusPIRone HCl TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629241501",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543074403",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629333301",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024716",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629333302",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335174907",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806066560",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335099101",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238111906",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090774201",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518198102",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090765201",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382018314",
      "ndc_label_name": "BusPIRone HCl TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117004302",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090486200",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014260",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518198100",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584009450",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518259100",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407037760",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335099102",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518280300",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090486201",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382018305",
      "ndc_label_name": "BusPIRone HCl TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518198103",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335099103",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518306500",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518338201",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335174902",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335099106",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090765200",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335174905",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518230000",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834027060",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518338200",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006605",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335174901",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771023860",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407041760",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006660",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335174904",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335174903",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162192706",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380074403",
      "ndc_label_name": "BusPIRone HCl TABLET 30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335174906",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117004301",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335245806",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584009406",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162192705",
      "ndc_label_name": "busPIRone HCl Tablet 30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904712261",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093005305",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093005301",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378114001",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155002301",
      "ndc_label_name": "BusPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720660",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378114005",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788005705",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155002305",
      "ndc_label_name": "BusPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720690",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788005701",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024401",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353060953",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008201",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440720630",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729020001",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300024405",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689078101",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729020016",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090579702",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407041301",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353060960",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543074107",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008205",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518272400",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090768202",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689078105",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020105",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651038901",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700093730",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806066205",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353060980",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205079990",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407041305",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806066201",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919016630",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919016690",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380074107",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090579701",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079098501",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610020380",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205079960",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090768201",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629240801",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919096590",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380074108",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079098520",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651038905",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610026780",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610026760",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382018005",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629240901",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382018001",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117004001",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407020101",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919016660",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030753",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030760",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518140400",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380074106",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788698403",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238111501",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959065430",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788698409",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834026605",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610060460",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610026753",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788698401",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788698406",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610082630",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788795201",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788795209",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425033403",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610060480",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030792",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584009110",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788795203",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610082653",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788795206",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205049390",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518068201",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006205",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610082660",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610026660",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518192401",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610094380",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117004002",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335056203",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610016560",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008005630",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610095930",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610060492",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610016580",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610020360",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69584009150",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610094392",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610026680",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610026653",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789013901",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610095960",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610060453",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610030780",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610016553",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610095980",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771023405",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610082680",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425033401",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610095992",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425050503",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610094353",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610020353",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162192405",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425033402",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610094360",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804006290",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189062890",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610095953",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006201",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162192401",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834026601",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771023401",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425050501",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425050502",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42543078706",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090707500",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407037801",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291017690",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729020101",
      "ndc_label_name": "BusPIRone HCl TABLET 7.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788005801",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378114501",
      "ndc_label_name": "BusPIRone HCl TABLET 7.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008305",
      "ndc_label_name": "BusPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687080111",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380078706",
      "ndc_label_name": "BusPIRone HCl TABLET 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700088130",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090561400",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008301",
      "ndc_label_name": "BusPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689078501",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090707501",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380078707",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804003960",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757109",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687080121",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238111601",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407041401",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651039001",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335282001",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382062301",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629727705",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189045830",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757103",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804003920",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610036060",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518283001",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006305",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757101",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610060860",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888006301",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518283000",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788757106",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771023501",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518316500",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834026701",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610034260",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610040460",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610048760",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162219901",
      "ndc_label_name": "busPIRone HCl Tablet 7.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779092204",
      "ndc_label_name": "Butalbital POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552090702",
      "ndc_label_name": "Butalbital POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779092205",
      "ndc_label_name": "Butalbital POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927244600",
      "ndc_label_name": "Butalbital POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552090704",
      "ndc_label_name": "Butalbital POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70010005401",
      "ndc_label_name": "Butalbital-Acetaminophen Capsule 50-300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862054401",
      "ndc_label_name": "Butalbital-Acetaminophen Capsule 50-300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907000801",
      "ndc_label_name": "Butalbital-Acetaminophen Capsule 50-300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71993030130",
      "ndc_label_name": "Butalbital-Acetaminophen Tablet 25-325 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73159000301",
      "ndc_label_name": "Butalbital-Acetaminophen Tablet 25-325 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71993030110",
      "ndc_label_name": "Butalbital-Acetaminophen Tablet 25-325 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862053801",
      "ndc_label_name": "Butalbital-Acetaminophen Tablet 50-300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573045502",
      "ndc_label_name": "Butalbital-Acetaminophen Tablet 50-300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752014710",
      "ndc_label_name": "Butalbital-Acetaminophen Tablet 50-300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682030601",
      "ndc_label_name": "Butalbital-Acetaminophen TABLET 50-300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81005012301",
      "ndc_label_name": "Butalbital-Acetaminophen Tablet 50-300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781064401",
      "ndc_label_name": "Butalbital-Acetaminophen Tablet 50-300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603254021",
      "ndc_label_name": "Butalbital-Acetaminophen TABLET 50-325 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573045602",
      "ndc_label_name": "Butalbital-Acetaminophen Tablet 50-325 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68047072130",
      "ndc_label_name": "Butalbital-Acetaminophen Tablet 50-325 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781062801",
      "ndc_label_name": "Butalbital-Acetaminophen Tablet 50-325 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68047072101",
      "ndc_label_name": "Butalbital-Acetaminophen TABLET 50-325 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752014810",
      "ndc_label_name": "Butalbital-Acetaminophen Tablet 50-325 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054065025",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-300-40-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591264101",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod CAPSULE 50-300-40-30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019401",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054300001",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440721130",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629315201",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019406",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591322001",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod CAPSULE 50-325-40-30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991007301",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod CAPSULE 50-325-40-30 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959091260",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019407",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019404",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629315202",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019405",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019402",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019403",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162159102",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591264005",
      "ndc_label_name": "Butalbital-APAP-Caffeine CAPSULE 50-300-40 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672422201",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-300-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547068610",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-300-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135062801",
      "ndc_label_name": "Butalbital-APAP-Caffeine CAPSULE 50-300-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291018101",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-300-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527409537",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-300-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534018704",
      "ndc_label_name": "Butalbital-APAP-Caffeine CAPSULE 50-300-40 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591264001",
      "ndc_label_name": "Butalbital-APAP-Caffeine CAPSULE 50-300-40 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010004401",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-300-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534018701",
      "ndc_label_name": "Butalbital-APAP-Caffeine CAPSULE 50-300-40 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862054201",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-300-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017001",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-300-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162123201",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-300-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42195095510",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-300-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629237201",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-300-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407020001",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-300-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010004405",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-300-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752014410",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-300-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096260",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-300-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049701",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-300-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425021501",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-300-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527409437",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-325-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107007501",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-325-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907000901",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-325-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862017901",
      "ndc_label_name": "Butalbital-APAP-Caffeine CAPSULE 50-325-40 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629208701",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-325-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13925053601",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-325-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752014110",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-325-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162109601",
      "ndc_label_name": "Butalbital-APAP-Caffeine Capsule 50-325-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950029016",
      "ndc_label_name": "Butalbital-APAP-Caffeine Solution 50-325-40 MG/15ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591336901",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527169505",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527169501",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603254428",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591336905",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603254421",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027560",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904693806",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027553",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023630",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781062505",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702025350",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090210500",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702025301",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781062501",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090704203",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436485602",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023653",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187052030",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436169501",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090210503",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023660",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090704200",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268055311",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429058905",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027530",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187093314",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436485601",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092030",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023670",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090751900",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687067265",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687067211",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027570",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752014210",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002230",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760086512",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090256400",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055605",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629177409",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187093330",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090256403",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098130",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693908",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002260",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268055313",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862054001",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693901",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084039611",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700066230",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036504",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813703",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002290",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055601",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092012",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879403",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813702",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429058901",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036505",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036503",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629215101",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862054005",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629214001",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010014901",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518299500",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135075101",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335227002",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036508",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380015701",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693902",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380015702",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518113401",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205051014",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187093390",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044130",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036509",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267003912",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693909",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518113400",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098160",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036507",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629177402",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420080290",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335227003",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084039665",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879402",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098100",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056702",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335176703",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010014905",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004253",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335254602",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693903",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367020305",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004260",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056703",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335227001",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518299501",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004270",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036502",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693906",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752014214",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044112",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044160",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335227004",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205051030",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420080260",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189060012",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367020301",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098155",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335227007",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420080212",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036500",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098172",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189060030",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420080230",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036501",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098190",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420080201",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056701",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036506",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335254603",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420080220",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335254604",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335263003",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004230",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189060060",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420080205",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420080210",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238199301",
      "ndc_label_name": "Butalbital-ASA-Caff-Codeine Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591354605",
      "ndc_label_name": "Butalbital-ASA-Caff-Codeine Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527131201",
      "ndc_label_name": "Butalbital-ASA-Caff-Codeine Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591354601",
      "ndc_label_name": "Butalbital-ASA-Caff-Codeine Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086530",
      "ndc_label_name": "Butalbital-ASA-Caff-Codeine Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086500",
      "ndc_label_name": "Butalbital-ASA-Caff-Codeine Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591321901",
      "ndc_label_name": "Butalbital-Aspirin-Caffeine Capsule 50-325-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781227001",
      "ndc_label_name": "Butalbital-Aspirin-Caffeine Capsule 50-325-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135043390",
      "ndc_label_name": "Butalbital-Aspirin-Caffeine Capsule 50-325-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033021501",
      "ndc_label_name": "Butalbital-Aspirin-Caffeine Capsule 50-325-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090158000",
      "ndc_label_name": "Butalbital-Aspirin-Caffeine Capsule 50-325-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527155201",
      "ndc_label_name": "Butalbital-Aspirin-Caffeine Capsule 50-325-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367041601",
      "ndc_label_name": "Butalbital-Aspirin-Caffeine Capsule 50-325-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090146500",
      "ndc_label_name": "Butalbital-Aspirin-Caffeine Capsule 50-325-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51927298600",
      "ndc_label_name": "Butorphanol Tartrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779176509",
      "ndc_label_name": "Butorphanol Tartrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592091711",
      "ndc_label_name": "Butorphanol Tartrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592091725",
      "ndc_label_name": "Butorphanol Tartrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779176500",
      "ndc_label_name": "Butorphanol Tartrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779176504",
      "ndc_label_name": "Butorphanol Tartrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991316201",
      "ndc_label_name": "Butorphanol Tartrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991316202",
      "ndc_label_name": "Butorphanol Tartrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779176506",
      "ndc_label_name": "Butorphanol Tartrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592091705",
      "ndc_label_name": "Butorphanol Tartrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779176505",
      "ndc_label_name": "Butorphanol Tartrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592091701",
      "ndc_label_name": "Butorphanol Tartrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592091710",
      "ndc_label_name": "Butorphanol Tartrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409162321",
      "ndc_label_name": "Butorphanol Tartrate Solution 1 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409162301",
      "ndc_label_name": "Butorphanol Tartrate SOLUTION 1 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505081301",
      "ndc_label_name": "Butorphanol Tartrate SOLUTION 10 MG/ML NASAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054309036",
      "ndc_label_name": "Butorphanol Tartrate SOLUTION 10 MG/ML NASAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162209902",
      "ndc_label_name": "Butorphanol Tartrate Solution 10 MG/ML Nasal",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409162601",
      "ndc_label_name": "Butorphanol Tartrate Solution 2 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409162602",
      "ndc_label_name": "Butorphanol Tartrate Solution 2 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409162642",
      "ndc_label_name": "Butorphanol Tartrate Solution 2 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409162621",
      "ndc_label_name": "Butorphanol Tartrate Solution 2 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59011075104",
      "ndc_label_name": "Butrans Patch Weekly 10 MCG/HR Transdermal",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59011075804",
      "ndc_label_name": "Butrans Patch Weekly 15 MCG/HR Transdermal",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59011075204",
      "ndc_label_name": "Butrans Patch Weekly 20 MCG/HR Transdermal",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59011075004",
      "ndc_label_name": "Butrans Patch Weekly 5 MCG/HR Transdermal",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59011075704",
      "ndc_label_name": "Butrans Patch Weekly 7.5 MCG/HR Transdermal",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51927216600",
      "ndc_label_name": "Butter Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927216500",
      "ndc_label_name": "Butter Rum Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927307200",
      "ndc_label_name": "Butterscotch Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991143901",
      "ndc_label_name": "Butterscotch Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991143902",
      "ndc_label_name": "Butterscotch Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991143903",
      "ndc_label_name": "Butterscotch Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991143904",
      "ndc_label_name": "Butterscotch Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60592001365",
      "ndc_label_name": "Butyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592001332",
      "ndc_label_name": "Butyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284301",
      "ndc_label_name": "Butyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284303",
      "ndc_label_name": "Butyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927184600",
      "ndc_label_name": "Butyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592001343",
      "ndc_label_name": "Butyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284302",
      "ndc_label_name": "Butyl Alcohol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927158700",
      "ndc_label_name": "Butylated Hydroxyanisole POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552009802",
      "ndc_label_name": "Butylated Hydroxytoluene CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552009806",
      "ndc_label_name": "Butylated Hydroxytoluene CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552009805",
      "ndc_label_name": "Butylated Hydroxytoluene CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552136003",
      "ndc_label_name": "Butylated Hydroxytoluene GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991131602",
      "ndc_label_name": "Butylated Hydroxytoluene POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991131601",
      "ndc_label_name": "Butylated Hydroxytoluene POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592002611",
      "ndc_label_name": "Butylated Hydroxytoluene Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592002605",
      "ndc_label_name": "Butylated Hydroxytoluene Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779006508",
      "ndc_label_name": "Butylated Hydroxytoluene POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927146300",
      "ndc_label_name": "Butylated Hydroxytoluene POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779006505",
      "ndc_label_name": "Butylated Hydroxytoluene POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592002601",
      "ndc_label_name": "Butylated Hydroxytoluene Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927300700",
      "ndc_label_name": "Butylene Glycol Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552016105",
      "ndc_label_name": "Butylparaben POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00310654001",
      "ndc_label_name": "Bydureon BCise Auto-Injector 2 MG/0.85ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310654004",
      "ndc_label_name": "Bydureon BCise Auto-Injector 2 MG/0.85ML Subcutaneous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310652401",
      "ndc_label_name": "Byetta 10 MCG Pen Solution Pen-Injector 10 MCG/0.04ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310651201",
      "ndc_label_name": "Byetta 5 MCG Pen Solution Pen-Injector 5 MCG/0.02ML Subcutaneous",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15054330101",
      "ndc_label_name": "Bylvay (Pellets) Capsule Sprinkle 200 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "74528002001",
      "ndc_label_name": "Bylvay (Pellets) Capsule Sprinkle 200 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "74528006001",
      "ndc_label_name": "Bylvay (Pellets) Capsule Sprinkle 600 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15054330301",
      "ndc_label_name": "Bylvay (Pellets) Capsule Sprinkle 600 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "74528012001",
      "ndc_label_name": "Bylvay Capsule 1200 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15054330401",
      "ndc_label_name": "Bylvay Capsule 1200 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15054330201",
      "ndc_label_name": "Bylvay Capsule 400 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "74528004001",
      "ndc_label_name": "Bylvay Capsule 400 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456141030",
      "ndc_label_name": "Bystolic Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130701",
      "ndc_label_name": "Bystolic Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456141090",
      "ndc_label_name": "Bystolic Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090130700",
      "ndc_label_name": "Bystolic Tablet 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456140263",
      "ndc_label_name": "Bystolic Tablet 2.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456140230",
      "ndc_label_name": "Bystolic Tablet 2.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456140211",
      "ndc_label_name": "Bystolic Tablet 2.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456142030",
      "ndc_label_name": "Bystolic Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090332600",
      "ndc_label_name": "Bystolic Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456142090",
      "ndc_label_name": "Bystolic Tablet 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456140590",
      "ndc_label_name": "Bystolic Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456140511",
      "ndc_label_name": "Bystolic Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090112700",
      "ndc_label_name": "Bystolic Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090112701",
      "ndc_label_name": "Bystolic Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456140563",
      "ndc_label_name": "Bystolic Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00456140530",
      "ndc_label_name": "Bystolic Tablet 5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23359010530",
      "ndc_label_name": "C-Nate DHA CAPSULE 28-1-200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452157002",
      "ndc_label_name": "Ca Phosphate Dibasic Dihyd POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552053006",
      "ndc_label_name": "Ca Phosphate Dibasic Dihyd POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452157001",
      "ndc_label_name": "Ca Phosphate Dibasic Dihyd POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452157003",
      "ndc_label_name": "Ca Phosphate Dibasic Dihyd Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49702025315",
      "ndc_label_name": "Cabenuva Suspension Extended Release 400 & 600 MG/2ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49702024015",
      "ndc_label_name": "Cabenuva Suspension Extended Release 600 & 900 MG/3ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49702026663",
      "ndc_label_name": "Cabenuva Suspension Extended Release 600 & 900 MG/3ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155082373",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090583400",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238269301",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093542088",
      "ndc_label_name": "Cabergoline TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512086008",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090315700",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742011808",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090659600",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762100501",
      "ndc_label_name": "Cabergoline TABLET 0.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090764200",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069082408",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58468022501",
      "ndc_label_name": "Cablivi Kit 11 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42388002426",
      "ndc_label_name": "Cabometyx Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42388002446",
      "ndc_label_name": "Cabometyx Tablet 20 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42388002526",
      "ndc_label_name": "Cabometyx Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42388002546",
      "ndc_label_name": "Cabometyx Tablet 40 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42388002326",
      "ndc_label_name": "Cabometyx Tablet 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42388002336",
      "ndc_label_name": "Cabometyx Tablet 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42388002346",
      "ndc_label_name": "Cabometyx Tablet 60 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069781030",
      "ndc_label_name": "Caduet Tablet 10-10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069216030",
      "ndc_label_name": "Caduet Tablet 10-10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069218030",
      "ndc_label_name": "Caduet Tablet 10-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069723230",
      "ndc_label_name": "Caduet Tablet 10-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069225030",
      "ndc_label_name": "Caduet Tablet 10-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069765430",
      "ndc_label_name": "Caduet Tablet 10-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069747630",
      "ndc_label_name": "Caduet Tablet 10-80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069227030",
      "ndc_label_name": "Caduet Tablet 10-80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069215030",
      "ndc_label_name": "Caduet Tablet 5-10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999098930",
      "ndc_label_name": "Caduet Tablet 5-10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069618030",
      "ndc_label_name": "Caduet Tablet 5-10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069632330",
      "ndc_label_name": "Caduet Tablet 5-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069217030",
      "ndc_label_name": "Caduet Tablet 5-20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069656530",
      "ndc_label_name": "Caduet Tablet 5-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069219030",
      "ndc_label_name": "Caduet Tablet 5-40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069674730",
      "ndc_label_name": "Caduet Tablet 5-80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069226030",
      "ndc_label_name": "Caduet Tablet 5-80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452132002",
      "ndc_label_name": "Caffeine Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452132004",
      "ndc_label_name": "Caffeine Anhydrous Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779041908",
      "ndc_label_name": "Caffeine Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552020007",
      "ndc_label_name": "Caffeine Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307007015",
      "ndc_label_name": "Caffeine Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779041907",
      "ndc_label_name": "Caffeine Anhydrous Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779041903",
      "ndc_label_name": "Caffeine Anhydrous Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779041905",
      "ndc_label_name": "Caffeine Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779041909",
      "ndc_label_name": "Caffeine Anhydrous Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991201501",
      "ndc_label_name": "Caffeine Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452132003",
      "ndc_label_name": "Caffeine Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552020009",
      "ndc_label_name": "Caffeine Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552020005",
      "ndc_label_name": "Caffeine Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991201506",
      "ndc_label_name": "Caffeine Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991201502",
      "ndc_label_name": "Caffeine Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452132001",
      "ndc_label_name": "Caffeine Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991201507",
      "ndc_label_name": "Caffeine Anhydrous Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927115800",
      "ndc_label_name": "Caffeine Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040601",
      "ndc_label_name": "Caffeine Citrate Solution 20 MG/ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040603",
      "ndc_label_name": "Caffeine Citrate SOLUTION 20 MG/ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517002010",
      "ndc_label_name": "Caffeine Citrate Solution 60 MG/3ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641626710",
      "ndc_label_name": "Caffeine Citrate Solution 60 MG/3ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571024469",
      "ndc_label_name": "Caffeine Citrate Solution 60 MG/3ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641626701",
      "ndc_label_name": "Caffeine Citrate Solution 60 MG/3ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335028926",
      "ndc_label_name": "Caffeine Citrate SOLUTION 60 MG/3ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021060103",
      "ndc_label_name": "Caffeine Citrate SOLUTION 60 MG/3ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335028927",
      "ndc_label_name": "Caffeine Citrate SOLUTION 60 MG/3ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754050001",
      "ndc_label_name": "Caffeine Citrate SOLUTION 60 MG/3ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485010401",
      "ndc_label_name": "Caffeine Citrate Solution 60 MG/3ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040703",
      "ndc_label_name": "Caffeine Citrate SOLUTION 60 MG/3ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150018703",
      "ndc_label_name": "Caffeine Citrate SOLUTION 60 MG/3ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323040704",
      "ndc_label_name": "Caffeine Citrate SOLUTION 60 MG/3ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485010410",
      "ndc_label_name": "Caffeine Citrate Solution 60 MG/3ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754050201",
      "ndc_label_name": "Caffeine Citrate Solution 60 MG/3ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021060203",
      "ndc_label_name": "Caffeine Citrate SOLUTION 60 MG/3ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335029040",
      "ndc_label_name": "Caffeine Citrate Solution 60 MG/3ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335029044",
      "ndc_label_name": "Caffeine Citrate Solution 60 MG/3ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754050103",
      "ndc_label_name": "Caffeine Citrate SOLUTION 60 MG/3ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754050303",
      "ndc_label_name": "Caffeine Citrate Solution 60 MG/3ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485011010",
      "ndc_label_name": "Caffeine Citrate Solution 60 MG/3ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927120200",
      "ndc_label_name": "Caffeine Citrated POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457995603",
      "ndc_label_name": "Caffeine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457995601",
      "ndc_label_name": "Caffeine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457995602",
      "ndc_label_name": "Caffeine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517250201",
      "ndc_label_name": "Caffeine-Sodium Benzoate Solution 125-125 MG/ML Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517250210",
      "ndc_label_name": "Caffeine-Sodium Benzoate SOLUTION 125-125 MG/ML INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592001505",
      "ndc_label_name": "Calamine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779006605",
      "ndc_label_name": "Calamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779006609",
      "ndc_label_name": "Calamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452135003",
      "ndc_label_name": "Calamine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779006608",
      "ndc_label_name": "Calamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552022307",
      "ndc_label_name": "Calamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991151401",
      "ndc_label_name": "Calamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452135004",
      "ndc_label_name": "Calamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991151403",
      "ndc_label_name": "Calamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452135001",
      "ndc_label_name": "Calamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927102200",
      "ndc_label_name": "Calamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552022304",
      "ndc_label_name": "Calamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60592001511",
      "ndc_label_name": "Calamine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592001510",
      "ndc_label_name": "Calamine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452135002",
      "ndc_label_name": "Calamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552022306",
      "ndc_label_name": "Calamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991151402",
      "ndc_label_name": "Calamine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00642006630",
      "ndc_label_name": "CalciFol WAFER 1342-1.6 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781711735",
      "ndc_label_name": "Calcipotriene Cream 0.005 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993087778",
      "ndc_label_name": "Calcipotriene CREAM 0.005 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407060512",
      "ndc_label_name": "Calcipotriene Cream 0.005 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462050165",
      "ndc_label_name": "Calcipotriene CREAM 0.005 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781711783",
      "ndc_label_name": "Calcipotriene Cream 0.005 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714076302",
      "ndc_label_name": "Calcipotriene Cream 0.005 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118997606",
      "ndc_label_name": "Calcipotriene CREAM 0.005 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714076301",
      "ndc_label_name": "Calcipotriene Cream 0.005 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407060560",
      "ndc_label_name": "Calcipotriene Cream 0.005 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462050166",
      "ndc_label_name": "Calcipotriene CREAM 0.005 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993087761",
      "ndc_label_name": "Calcipotriene CREAM 0.005 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162216006",
      "ndc_label_name": "Calcipotriene Cream 0.005 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862051260",
      "ndc_label_name": "Calcipotriene Foam 0.005 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73352088660",
      "ndc_label_name": "Calcipotriene Foam 0.005 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552145802",
      "ndc_label_name": "Calcipotriene Monohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552145803",
      "ndc_label_name": "Calcipotriene Monohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991319201",
      "ndc_label_name": "Calcipotriene Monohydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991319202",
      "ndc_label_name": "Calcipotriene Monohydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552145804",
      "ndc_label_name": "Calcipotriene Monohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991319203",
      "ndc_label_name": "Calcipotriene Monohydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993087878",
      "ndc_label_name": "Calcipotriene Ointment 0.005 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672415403",
      "ndc_label_name": "Calcipotriene OINTMENT 0.005 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672415404",
      "ndc_label_name": "Calcipotriene OINTMENT 0.005 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462031065",
      "ndc_label_name": "Calcipotriene Ointment 0.005 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993087861",
      "ndc_label_name": "Calcipotriene Ointment 0.005 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407060612",
      "ndc_label_name": "Calcipotriene Ointment 0.005 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407060660",
      "ndc_label_name": "Calcipotriene Ointment 0.005 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462031066",
      "ndc_label_name": "Calcipotriene Ointment 0.005 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052047625",
      "ndc_label_name": "Calcipotriene Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052047605",
      "ndc_label_name": "Calcipotriene Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713031853",
      "ndc_label_name": "Calcipotriene Solution 0.005 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383073202",
      "ndc_label_name": "Calcipotriene Solution 0.005 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168040060",
      "ndc_label_name": "Calcipotriene Solution 0.005 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629252001",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Ointment 0.005-0.064 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802081696",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Ointment 0.005-0.064 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781716535",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Ointment 0.005-0.064 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802081601",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Ointment 0.005-0.064 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781716595",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Ointment 0.005-0.064 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629861701",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Ointment 0.005-0.064 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162142806",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Ointment 0.005-0.064 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993093861",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Ointment 0.005-0.064 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993093865",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Ointment 0.005-0.064 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162142801",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Ointment 0.005-0.064 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802088996",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Suspension 0.005-0.064 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713084892",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Suspension 0.005-0.064 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993093761",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Suspension 0.005-0.064 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802088918",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Suspension 0.005-0.064 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672140208",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Suspension 0.005-0.064 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672140204",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Suspension 0.005-0.064 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713084860",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Suspension 0.005-0.064 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63646004060",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Suspension 0.005-0.064 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993093778",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Suspension 0.005-0.064 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629861901",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Suspension 0.005-0.064 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63646004012",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Suspension 0.005-0.064 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629861801",
      "ndc_label_name": "Calcipotriene-Betameth Diprop Suspension 0.005-0.064 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779307506",
      "ndc_label_name": "Calcipotriol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779288509",
      "ndc_label_name": "Calcipotriol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779288500",
      "ndc_label_name": "Calcipotriol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779288506",
      "ndc_label_name": "Calcipotriol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779307509",
      "ndc_label_name": "Calcipotriol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779307503",
      "ndc_label_name": "Calcipotriol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779288503",
      "ndc_label_name": "Calcipotriol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779307500",
      "ndc_label_name": "Calcipotriol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884016111",
      "ndc_label_name": "Calcitonin (Salmon) SOLUTION 200 UNIT/ACT NASAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162212803",
      "ndc_label_name": "Calcitonin (Salmon) Solution 200 UNIT/ACT Nasal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629215201",
      "ndc_label_name": "Calcitonin (Salmon) Solution 200 UNIT/ACT Nasal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505082306",
      "ndc_label_name": "Calcitonin (Salmon) SOLUTION 200 UNIT/ACT NASAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323086502",
      "ndc_label_name": "Calcitonin (Salmon) Solution 200 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598005111",
      "ndc_label_name": "Calcitonin (Salmon) Solution 200 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021047302",
      "ndc_label_name": "Calcitonin (Salmon) Solution 200 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24201040002",
      "ndc_label_name": "Calcitonin (Salmon) Solution 200 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097077032",
      "ndc_label_name": "Calcitonin (Salmon) Solution 200 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023020501",
      "ndc_label_name": "Calcitonin (Salmon) Solution 200 UNIT/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672527803",
      "ndc_label_name": "Calcitrene OINTMENT 0.005 % EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054000713",
      "ndc_label_name": "Calcitriol CAPSULE 0.25 MCG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353013809",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090671100",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353003430",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155066201",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407016930",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155066203",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054000725",
      "ndc_label_name": "Calcitriol CAPSULE 0.25 MCG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093735201",
      "ndc_label_name": "Calcitriol CAPSULE 0.25 MCG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610046809",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687034511",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353003481",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353063381",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135061090",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090747000",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353003409",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353063309",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610052109",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756096783",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353099809",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756096788",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789005801",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407016901",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353013830",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380072306",
      "ndc_label_name": "Calcitriol CAPSULE 0.25 MCG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162192003",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452020720",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304023901",
      "ndc_label_name": "Calcitriol CAPSULE 0.25 MCG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789005830",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353063330",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629244501",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629874101",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610087030",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687034501",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452020713",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304023930",
      "ndc_label_name": "Calcitriol CAPSULE 0.25 MCG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380072304",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610046830",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162103101",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135061190",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304024001",
      "ndc_label_name": "Calcitriol CAPSULE 0.5 MCG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155066301",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629874201",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093735301",
      "ndc_label_name": "Calcitriol CAPSULE 0.5 MCG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452020820",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407017001",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380072406",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756096888",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927342200",
      "ndc_label_name": "Calcitriol in Almond Oil OIL 1000 NANOGM/ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927478800",
      "ndc_label_name": "Calcitriol in Almond Oil OIL 1000 NANOGM/ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308066510",
      "ndc_label_name": "Calcitriol Ointment 3 MCG/GM External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802060801",
      "ndc_label_name": "Calcitriol OINTMENT 3 MCG/GM EXTERNAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927342900",
      "ndc_label_name": "Calcitriol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927478100",
      "ndc_label_name": "Calcitriol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266025101",
      "ndc_label_name": "Calcitriol Solution 1 MCG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478093101",
      "ndc_label_name": "Calcitriol Solution 1 MCG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266025110",
      "ndc_label_name": "Calcitriol Solution 1 MCG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054312041",
      "ndc_label_name": "Calcitriol SOLUTION 1 MCG/ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980044715",
      "ndc_label_name": "Calcitriol Solution 1 MCG/ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304024159",
      "ndc_label_name": "Calcitriol SOLUTION 1 MCG/ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781208102",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155053102",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054008813",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571081320",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29033002602",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904711961",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904711906",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789042297",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291018920",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51293082502",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054008826",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429049102",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097086283",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135062902",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135019122",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096800",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096820",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367041102",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689079302",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094004461",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834032302",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856008802",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084047901",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096878",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096855",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282037702",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73190003120",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180013415",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096860",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096830",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084047911",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518237200",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096872",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096864",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094004459",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096890",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518272300",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155062102",
      "ndc_label_name": "Calcium Acetate (Phos Binder) TABLET 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00536133632",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Tablet 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71321080320",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Tablet 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452135901",
      "ndc_label_name": "Calcium Acetate Crystals",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452135902",
      "ndc_label_name": "Calcium Acetate Crystals",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452135903",
      "ndc_label_name": "Calcium Acetate Crystals",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452135904",
      "ndc_label_name": "Calcium Acetate Crystals",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927182800",
      "ndc_label_name": "Calcium Acetate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135019222",
      "ndc_label_name": "Calcium Acetate Tablet 667 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927236100",
      "ndc_label_name": "Calcium Alginate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779290808",
      "ndc_label_name": "Calcium Amino Acid Chelate GRANULES 30 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779290805",
      "ndc_label_name": "Calcium Amino Acid Chelate GRANULES 30 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779290809",
      "ndc_label_name": "Calcium Amino Acid Chelate GRANULES 30 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779290801",
      "ndc_label_name": "Calcium Amino Acid Chelate GRANULES 30 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779290804",
      "ndc_label_name": "Calcium Amino Acid Chelate GRANULES 30 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779290807",
      "ndc_label_name": "Calcium Amino Acid Chelate GRANULES 30 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452136601",
      "ndc_label_name": "Calcium Ascorbate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452136602",
      "ndc_label_name": "Calcium Ascorbate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927163500",
      "ndc_label_name": "Calcium Ascorbate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063078493",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet 500-5 MG-MCG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43063078494",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet 500-5 MG-MCG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552023105",
      "ndc_label_name": "Calcium Carbonate Extra Light POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552023104",
      "ndc_label_name": "Calcium Carbonate Extra Light POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552023108",
      "ndc_label_name": "Calcium Carbonate Extra Light POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552023109",
      "ndc_label_name": "Calcium Carbonate Extra Light POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452138001",
      "ndc_label_name": "Calcium Carbonate Light POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452138002",
      "ndc_label_name": "Calcium Carbonate Light POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927194400",
      "ndc_label_name": "Calcium Carbonate Light POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452138003",
      "ndc_label_name": "Calcium Carbonate Light POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779054901",
      "ndc_label_name": "Calcium Carbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552001807",
      "ndc_label_name": "Calcium Carbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452137001",
      "ndc_label_name": "Calcium Carbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00395043101",
      "ndc_label_name": "Calcium Carbonate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779054908",
      "ndc_label_name": "Calcium Carbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452137003",
      "ndc_label_name": "Calcium Carbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452137006",
      "ndc_label_name": "Calcium Carbonate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991201602",
      "ndc_label_name": "Calcium Carbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452137002",
      "ndc_label_name": "Calcium Carbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452137005",
      "ndc_label_name": "Calcium Carbonate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552001805",
      "ndc_label_name": "Calcium Carbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927104400",
      "ndc_label_name": "Calcium Carbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452137004",
      "ndc_label_name": "Calcium Carbonate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991201601",
      "ndc_label_name": "Calcium Carbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991201603",
      "ndc_label_name": "Calcium Carbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991201604",
      "ndc_label_name": "Calcium Carbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452140001",
      "ndc_label_name": "Calcium Chloride Anhydrous GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452140003",
      "ndc_label_name": "Calcium Chloride Anhydrous Granules",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452140002",
      "ndc_label_name": "Calcium Chloride Anhydrous GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927285600",
      "ndc_label_name": "Calcium Chloride Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452141003",
      "ndc_label_name": "Calcium Chloride Dihydrate GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452141102",
      "ndc_label_name": "Calcium Chloride Dihydrate Granules",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452141103",
      "ndc_label_name": "Calcium Chloride Dihydrate Granules",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452141002",
      "ndc_label_name": "Calcium Chloride Dihydrate GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927513500",
      "ndc_label_name": "Calcium Chloride Dihydrate Granules",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452141001",
      "ndc_label_name": "Calcium Chloride Dihydrate GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452141101",
      "ndc_label_name": "Calcium Chloride Dihydrate Granules",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991304001",
      "ndc_label_name": "Calcium Chloride Dihydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927120500",
      "ndc_label_name": "Calcium Chloride Dihydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991304002",
      "ndc_label_name": "Calcium Chloride Dihydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991304003",
      "ndc_label_name": "Calcium Chloride Dihydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409163140",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409492834",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069077301",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374091310",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409492811",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253090036",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409163110",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517271025",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517671010",
      "ndc_label_name": "Calcium Chloride SOLUTION 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069077310",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121230801",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253090030",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517671001",
      "ndc_label_name": "Calcium Chloride SOLUTION 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121230804",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572005201",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253090091",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090236100",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121230901",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518320500",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81483000500",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572005210",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121230907",
      "ndc_label_name": "Calcium Chloride Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76329330401",
      "ndc_label_name": "Calcium Chloride SOLUTION 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779108000",
      "ndc_label_name": "Calcium Citrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779108001",
      "ndc_label_name": "Calcium Citrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779108003",
      "ndc_label_name": "Calcium Citrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779108005",
      "ndc_label_name": "Calcium Citrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779108009",
      "ndc_label_name": "Calcium Citrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779108008",
      "ndc_label_name": "Calcium Citrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452142503",
      "ndc_label_name": "Calcium Citrate Tetrahydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552081907",
      "ndc_label_name": "Calcium Citrate Tetrahydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991152504",
      "ndc_label_name": "Calcium Citrate Tetrahydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452142502",
      "ndc_label_name": "Calcium Citrate Tetrahydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927134600",
      "ndc_label_name": "Calcium Citrate Tetrahydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991152501",
      "ndc_label_name": "Calcium Citrate Tetrahydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452142501",
      "ndc_label_name": "Calcium Citrate Tetrahydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991152502",
      "ndc_label_name": "Calcium Citrate Tetrahydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991152503",
      "ndc_label_name": "Calcium Citrate Tetrahydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "99207024005",
      "ndc_label_name": "Calcium Disodium Versenate Solution 1 GM/5ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991273701",
      "ndc_label_name": "Calcium Folinate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991273703",
      "ndc_label_name": "Calcium Folinate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991273704",
      "ndc_label_name": "Calcium Folinate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991273702",
      "ndc_label_name": "Calcium Folinate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991273705",
      "ndc_label_name": "Calcium Folinate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927499700",
      "ndc_label_name": "Calcium Fructoborate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927339800",
      "ndc_label_name": "Calcium Glubionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927483200",
      "ndc_label_name": "Calcium Glubionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991285201",
      "ndc_label_name": "Calcium Gluconate Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452146101",
      "ndc_label_name": "Calcium Gluconate Anhydrous Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779182608",
      "ndc_label_name": "Calcium Gluconate Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452146103",
      "ndc_label_name": "Calcium Gluconate Anhydrous Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552051506",
      "ndc_label_name": "Calcium Gluconate Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991285202",
      "ndc_label_name": "Calcium Gluconate Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452146102",
      "ndc_label_name": "Calcium Gluconate Anhydrous Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927111700",
      "ndc_label_name": "Calcium Gluconate Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927442700",
      "ndc_label_name": "Calcium Gluconate Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552051509",
      "ndc_label_name": "Calcium Gluconate Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991285203",
      "ndc_label_name": "Calcium Gluconate Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592004410",
      "ndc_label_name": "Calcium Gluconate Monohydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452146501",
      "ndc_label_name": "Calcium Gluconate Monohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452146502",
      "ndc_label_name": "Calcium Gluconate Monohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452146503",
      "ndc_label_name": "Calcium Gluconate Monohydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991302102",
      "ndc_label_name": "Calcium Gluconate Monohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991302101",
      "ndc_label_name": "Calcium Gluconate Monohydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592004411",
      "ndc_label_name": "Calcium Gluconate Monohydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592004461",
      "ndc_label_name": "Calcium Gluconate Monohydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927490000",
      "ndc_label_name": "Calcium Gluconate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143918401",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264560052",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143918001",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323036019",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090236200",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323036001",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143918025",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143918425",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323036003",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323036005",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143918501",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219063001",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069072801",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219063019",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143918520",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323036061",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323036059",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069072701",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090339800",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069072725",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069072820",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069072710",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830167402",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830167302",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069072810",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834017119",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80830167202",
      "ndc_label_name": "Calcium Gluconate Solution 10 % Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70092123503",
      "ndc_label_name": "Calcium Gluconate-NaCl Solution 2-0.9 GM/100ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452147001",
      "ndc_label_name": "Calcium Glycerophosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452147002",
      "ndc_label_name": "Calcium Glycerophosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452147003",
      "ndc_label_name": "Calcium Glycerophosphate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452147004",
      "ndc_label_name": "Calcium Glycerophosphate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452148003",
      "ndc_label_name": "Calcium Hydroxide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927120600",
      "ndc_label_name": "Calcium Hydroxide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452148001",
      "ndc_label_name": "Calcium Hydroxide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452148002",
      "ndc_label_name": "Calcium Hydroxide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552016706",
      "ndc_label_name": "Calcium Hydroxide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927287600",
      "ndc_label_name": "Calcium Hydroxyapatite POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991141902",
      "ndc_label_name": "Calcium Lactate Pentahydrate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452152002",
      "ndc_label_name": "Calcium Lactate Pentahydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927158200",
      "ndc_label_name": "Calcium Lactate Pentahydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991141903",
      "ndc_label_name": "Calcium Lactate Pentahydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927267900",
      "ndc_label_name": "Calcium Levulinate Dihydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452153502",
      "ndc_label_name": "Calcium Oxide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452153501",
      "ndc_label_name": "Calcium Oxide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452153503",
      "ndc_label_name": "Calcium Oxide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779087605",
      "ndc_label_name": "Calcium Pantothenate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779087608",
      "ndc_label_name": "Calcium Pantothenate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779087604",
      "ndc_label_name": "Calcium Pantothenate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452154001",
      "ndc_label_name": "Calcium Pantothenate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452154005",
      "ndc_label_name": "Calcium Pantothenate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779087609",
      "ndc_label_name": "Calcium Pantothenate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927192000",
      "ndc_label_name": "Calcium Pantothenate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452154002",
      "ndc_label_name": "Calcium Pantothenate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991161304",
      "ndc_label_name": "Calcium Pantothenate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452154004",
      "ndc_label_name": "Calcium Pantothenate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991161302",
      "ndc_label_name": "Calcium Pantothenate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991161301",
      "ndc_label_name": "Calcium Pantothenate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991161303",
      "ndc_label_name": "Calcium Pantothenate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779284301",
      "ndc_label_name": "Calcium Phosphate Dibasic POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779284305",
      "ndc_label_name": "Calcium Phosphate Dibasic POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779284309",
      "ndc_label_name": "Calcium Phosphate Dibasic POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452155203",
      "ndc_label_name": "Calcium Phosphate Dibasic Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452155201",
      "ndc_label_name": "Calcium Phosphate Dibasic Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452155202",
      "ndc_label_name": "Calcium Phosphate Dibasic Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927124900",
      "ndc_label_name": "Calcium Phosphate Dibasic POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452158001",
      "ndc_label_name": "Calcium Phosphate Tribasic POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452158003",
      "ndc_label_name": "Calcium Phosphate Tribasic Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452158002",
      "ndc_label_name": "Calcium Phosphate Tribasic POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552059406",
      "ndc_label_name": "Calcium Phosphate Tribasic POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927125000",
      "ndc_label_name": "Calcium Phosphate Tribasic POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452159001",
      "ndc_label_name": "Calcium Propionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452159002",
      "ndc_label_name": "Calcium Propionate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452159003",
      "ndc_label_name": "Calcium Propionate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927305200",
      "ndc_label_name": "Calcium Pyruvate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452160001",
      "ndc_label_name": "Calcium Saccharate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452160003",
      "ndc_label_name": "Calcium Saccharate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452160002",
      "ndc_label_name": "Calcium Saccharate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552097705",
      "ndc_label_name": "Calcium Saccharate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552097707",
      "ndc_label_name": "Calcium Saccharate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927286000",
      "ndc_label_name": "Calcium Saccharin CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452160701",
      "ndc_label_name": "Calcium Silicate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452160703",
      "ndc_label_name": "Calcium Silicate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452160702",
      "ndc_label_name": "Calcium Silicate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452161001",
      "ndc_label_name": "Calcium Stearate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452161003",
      "ndc_label_name": "Calcium Stearate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452161002",
      "ndc_label_name": "Calcium Stearate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927265400",
      "ndc_label_name": "Calcium Sulfate Hemihydrate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452163001",
      "ndc_label_name": "Calcium Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452163002",
      "ndc_label_name": "Calcium Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452163003",
      "ndc_label_name": "Calcium Sulfate Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927309200",
      "ndc_label_name": "Calcium Sulfate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452162002",
      "ndc_label_name": "Calcium Sulfate POWDER 90 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452162001",
      "ndc_label_name": "Calcium Sulfate POWDER 90 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452162003",
      "ndc_label_name": "Calcium Sulfate Powder 90 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927209000",
      "ndc_label_name": "Calcium Thioglycolate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42192070660",
      "ndc_label_name": "Calcium-Folic Acid Plus D Wafer 1342-1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66220028708",
      "ndc_label_name": "Caldolor SOLUTION 800 MG/8ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310451360",
      "ndc_label_name": "Calquence Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310351260",
      "ndc_label_name": "Calquence Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81877063060",
      "ndc_label_name": "Calsodore Kit 0.005 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81877064060",
      "ndc_label_name": "Calsodore Therapy Pack 0.005-5 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862088401",
      "ndc_label_name": "Camila Tablet 0.35 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907007428",
      "ndc_label_name": "Camila Tablet 0.35 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907007432",
      "ndc_label_name": "Camila Tablet 0.35 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862088403",
      "ndc_label_name": "Camila Tablet 0.35 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00395045591",
      "ndc_label_name": "Camphor Blocks Gum",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552039606",
      "ndc_label_name": "Camphor CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779038607",
      "ndc_label_name": "Camphor CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779038603",
      "ndc_label_name": "Camphor Crystals",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552039604",
      "ndc_label_name": "Camphor CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779038608",
      "ndc_label_name": "Camphor CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991122402",
      "ndc_label_name": "Camphor CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779038605",
      "ndc_label_name": "Camphor CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991122406",
      "ndc_label_name": "Camphor CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991122401",
      "ndc_label_name": "Camphor CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991122405",
      "ndc_label_name": "Camphor CRYSTALS",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452164003",
      "ndc_label_name": "Camphor GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452164001",
      "ndc_label_name": "Camphor GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452164002",
      "ndc_label_name": "Camphor GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927120000",
      "ndc_label_name": "Camphor GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00395046716",
      "ndc_label_name": "Camphor Spirit (Bulk) Spirit",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000039601",
      "ndc_label_name": "Camphor Spirit (Bulk) Spirit",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00395046792",
      "ndc_label_name": "Camphor Spirit (Bulk) Spirit",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00093614882",
      "ndc_label_name": "Camrese Lo TABLET 0.1-0.02 & 0.01 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093614891",
      "ndc_label_name": "Camrese Lo TABLET 0.1-0.02 & 0.01 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093313482",
      "ndc_label_name": "Camrese TABLET 0.15-0.03 &0.01 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093313491",
      "ndc_label_name": "Camrese TABLET 0.15-0.03 &0.01 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73625011311",
      "ndc_label_name": "Camzyos Capsule 10 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73625011411",
      "ndc_label_name": "Camzyos Capsule 15 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73625011111",
      "ndc_label_name": "Camzyos Capsule 2.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73625011211",
      "ndc_label_name": "Camzyos Capsule 5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927229500",
      "ndc_label_name": "Canadian Balsam Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452166001",
      "ndc_label_name": "Canadian Balsam Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452166002",
      "ndc_label_name": "Canadian Balsam Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452166003",
      "ndc_label_name": "Canadian Balsam Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58914050156",
      "ndc_label_name": "Canasa Suppository 1000 MG Rectal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006382210",
      "ndc_label_name": "Cancidas Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006382310",
      "ndc_label_name": "Cancidas Solution Reconstituted 70 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687024125",
      "ndc_label_name": "Candesartan Cilexetil Tablet 16 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342011610",
      "ndc_label_name": "Candesartan Cilexetil TABLET 16 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884066009",
      "ndc_label_name": "Candesartan Cilexetil TABLET 16 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378323177",
      "ndc_label_name": "Candesartan Cilexetil Tablet 16 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407088490",
      "ndc_label_name": "Candesartan Cilexetil Tablet 16 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687024195",
      "ndc_label_name": "Candesartan Cilexetil Tablet 16 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378323193",
      "ndc_label_name": "Candesartan Cilexetil Tablet 16 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342011607",
      "ndc_label_name": "Candesartan Cilexetil TABLET 16 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332034330",
      "ndc_label_name": "Candesartan Cilexetil Tablet 16 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518271900",
      "ndc_label_name": "Candesartan Cilexetil Tablet 16 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332034390",
      "ndc_label_name": "Candesartan Cilexetil Tablet 16 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603072001",
      "ndc_label_name": "Candesartan Cilexetil Tablet 16 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378323277",
      "ndc_label_name": "Candesartan Cilexetil Tablet 32 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342011707",
      "ndc_label_name": "Candesartan Cilexetil TABLET 32 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884066109",
      "ndc_label_name": "Candesartan Cilexetil Tablet 32 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378323293",
      "ndc_label_name": "Candesartan Cilexetil Tablet 32 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407088590",
      "ndc_label_name": "Candesartan Cilexetil Tablet 32 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342011710",
      "ndc_label_name": "Candesartan Cilexetil TABLET 32 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332006030",
      "ndc_label_name": "Candesartan Cilexetil TABLET 32 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332006090",
      "ndc_label_name": "Candesartan Cilexetil TABLET 32 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687013095",
      "ndc_label_name": "Candesartan Cilexetil Tablet 32 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687013025",
      "ndc_label_name": "Candesartan Cilexetil Tablet 32 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603072101",
      "ndc_label_name": "Candesartan Cilexetil Tablet 32 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342011410",
      "ndc_label_name": "Candesartan Cilexetil Tablet 4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332034190",
      "ndc_label_name": "Candesartan Cilexetil Tablet 4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629212601",
      "ndc_label_name": "Candesartan Cilexetil Tablet 4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162151009",
      "ndc_label_name": "Candesartan Cilexetil Tablet 4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342011407",
      "ndc_label_name": "Candesartan Cilexetil TABLET 4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378322477",
      "ndc_label_name": "Candesartan Cilexetil Tablet 4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884065809",
      "ndc_label_name": "Candesartan Cilexetil Tablet 4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378322493",
      "ndc_label_name": "Candesartan Cilexetil Tablet 4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332034130",
      "ndc_label_name": "Candesartan Cilexetil Tablet 4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407088290",
      "ndc_label_name": "Candesartan Cilexetil Tablet 4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378322577",
      "ndc_label_name": "Candesartan Cilexetil Tablet 8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332034230",
      "ndc_label_name": "Candesartan Cilexetil Tablet 8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378322593",
      "ndc_label_name": "Candesartan Cilexetil Tablet 8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342011507",
      "ndc_label_name": "Candesartan Cilexetil TABLET 8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407088390",
      "ndc_label_name": "Candesartan Cilexetil Tablet 8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518288400",
      "ndc_label_name": "Candesartan Cilexetil Tablet 8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884065909",
      "ndc_label_name": "Candesartan Cilexetil TABLET 8 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342011510",
      "ndc_label_name": "Candesartan Cilexetil Tablet 8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332034290",
      "ndc_label_name": "Candesartan Cilexetil Tablet 8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162151109",
      "ndc_label_name": "Candesartan Cilexetil Tablet 8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687011925",
      "ndc_label_name": "Candesartan Cilexetil Tablet 8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629212701",
      "ndc_label_name": "Candesartan Cilexetil Tablet 8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687011995",
      "ndc_label_name": "Candesartan Cilexetil Tablet 8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547045909",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ Tablet 16-12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378300177",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ TABLET 16-12.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559066090",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ Tablet 16-12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342013110",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ TABLET 16-12.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342013115",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ TABLET 16-12.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559066190",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ Tablet 32-12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547046009",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ Tablet 32-12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378300277",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ TABLET 32-12.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518272000",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ Tablet 32-12.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342013210",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ TABLET 32-12.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342013215",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ TABLET 32-12.5 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378300377",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ TABLET 32-25 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547046109",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ Tablet 32-25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342013310",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ TABLET 32-25 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342013315",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ TABLET 32-25 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378300305",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ Tablet 32-25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559066290",
      "ndc_label_name": "Candesartan Cilexetil-HCTZ Tablet 32-25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65044505202",
      "ndc_label_name": "Candida Albicans Extract Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65044505201",
      "ndc_label_name": "Candida Albicans Extract Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65044505204",
      "ndc_label_name": "Candida Albicans Extract Solution 100 MG/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65044505301",
      "ndc_label_name": "Candida Albicans Skn Tst Antgn Solution 1:10 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65044505405",
      "ndc_label_name": "Candida Albicans Skn Tst Antgn Solution Intradermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59584013801",
      "ndc_label_name": "Candin Solution Intradermal",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779314803",
      "ndc_label_name": "Cannabidiol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779314804",
      "ndc_label_name": "Cannabidiol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779314805",
      "ndc_label_name": "Cannabidiol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927507400",
      "ndc_label_name": "Cannabidiol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779314808",
      "ndc_label_name": "Cannabidiol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779314806",
      "ndc_label_name": "Cannabidiol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991165201",
      "ndc_label_name": "Cantharidin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779038904",
      "ndc_label_name": "Cantharidin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991165205",
      "ndc_label_name": "Cantharidin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779038900",
      "ndc_label_name": "Cantharidin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779038903",
      "ndc_label_name": "Cantharidin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927263800",
      "ndc_label_name": "Cantharidin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991165203",
      "ndc_label_name": "Cantharidin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779038909",
      "ndc_label_name": "Cantharidin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991165202",
      "ndc_label_name": "Cantharidin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052029405",
      "ndc_label_name": "Cantharidin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779038906",
      "ndc_label_name": "Cantharidin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991165204",
      "ndc_label_name": "Cantharidin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052029401",
      "ndc_label_name": "Cantharidin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714046701",
      "ndc_label_name": "Capecitabine TABLET 150 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378251191",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407063960",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054027121",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407009560",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111049660",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162084306",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093747306",
      "ndc_label_name": "Capecitabine TABLET 150 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877045860",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756081560",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651020460",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923072160",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980027606",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729007212",
      "ndc_label_name": "Capecitabine TABLET 150 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485020460",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135078360",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205000660",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722077460",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097094903",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001048706",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82249020760",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756023886",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001064306",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111049704",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093747489",
      "ndc_label_name": "Capecitabine TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054027223",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877045912",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079051005",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378251278",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729007329",
      "ndc_label_name": "Capecitabine TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722077512",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687014911",
      "ndc_label_name": "Capecitabine TABLET 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001064407",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714046801",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097094808",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980027712",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722077560",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756023920",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268015411",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603030301",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268015413",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079051001",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756081622",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009011212",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407064012",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651020508",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407009612",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162084416",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923072212",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485020512",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687014994",
      "ndc_label_name": "Capecitabine TABLET 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135078412",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001048807",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205000792",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82249021012",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72060011040",
      "ndc_label_name": "Caplyta Capsule 10.5 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72060012140",
      "ndc_label_name": "Caplyta Capsule 21 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72060014230",
      "ndc_label_name": "Caplyta Capsule 42 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72060014240",
      "ndc_label_name": "Caplyta Capsule 42 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58468782003",
      "ndc_label_name": "Caprelsa Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58468784003",
      "ndc_label_name": "Caprelsa Tablet 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927139700",
      "ndc_label_name": "Caprylic Acid Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779255402",
      "ndc_label_name": "Caprylic Capric Triglyceride Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779255409",
      "ndc_label_name": "Caprylic Capric Triglyceride Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309309",
      "ndc_label_name": "Caprylic Capric Triglyceride Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779255401",
      "ndc_label_name": "Caprylic Capric Triglyceride Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927260400",
      "ndc_label_name": "Caprylic Capric Triglyceride Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69203052850",
      "ndc_label_name": "Capsaicin Palmitate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991101701",
      "ndc_label_name": "Capsaicin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552012902",
      "ndc_label_name": "Capsaicin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991101702",
      "ndc_label_name": "Capsaicin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452132101",
      "ndc_label_name": "Capsaicin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452132102",
      "ndc_label_name": "Capsaicin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991201702",
      "ndc_label_name": "Capsaicin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991201701",
      "ndc_label_name": "Capsaicin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452132103",
      "ndc_label_name": "Capsaicin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552012901",
      "ndc_label_name": "Capsaicin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452132104",
      "ndc_label_name": "Capsaicin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927180700",
      "ndc_label_name": "Capsaicin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991101703",
      "ndc_label_name": "Capsaicin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779277705",
      "ndc_label_name": "Capsaicin POWDER 95 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779083703",
      "ndc_label_name": "Capsaicin POWDER 95 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779083705",
      "ndc_label_name": "Capsaicin POWDER 95 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779083706",
      "ndc_label_name": "Capsaicin POWDER 95 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779277703",
      "ndc_label_name": "Capsaicin POWDER 95 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779277706",
      "ndc_label_name": "Capsaicin POWDER 95 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991312903",
      "ndc_label_name": "Capsaicin POWDER 98.3 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991312901",
      "ndc_label_name": "Capsaicin POWDER 98.3 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991312902",
      "ndc_label_name": "Capsaicin POWDER 98.3 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69420900101",
      "ndc_label_name": "CapsFenac Pak Therapy Pack 1.5 & 0.025 % External",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927309100",
      "ndc_label_name": "Capsicum Oleoresin Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72467022565",
      "ndc_label_name": "CapsOral w/Dynamic Static Grd Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72467022575",
      "ndc_label_name": "CapsOral w/Dynamic Static Grd Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72467022540",
      "ndc_label_name": "CapsOral w/Dynamic Static Grd Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467022550",
      "ndc_label_name": "CapsOral w/Dynamic Static Grd Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72467022570",
      "ndc_label_name": "CapsOral w/Dynamic Static Grd Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72467022555",
      "ndc_label_name": "CapsOral w/Dynamic Static Grd Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779259505",
      "ndc_label_name": "CapsuBlend-H POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779259508",
      "ndc_label_name": "CapsuBlend-H POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779259509",
      "ndc_label_name": "CapsuBlend-H Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779259409",
      "ndc_label_name": "CapsuBlend-P POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779259408",
      "ndc_label_name": "CapsuBlend-P POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779259405",
      "ndc_label_name": "CapsuBlend-P POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779259308",
      "ndc_label_name": "CapsuBlend-S POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779259309",
      "ndc_label_name": "CapsuBlend-S POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779259305",
      "ndc_label_name": "CapsuBlend-S POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779319409",
      "ndc_label_name": "Capsule #0 Clear/Clear Veg Capsule",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779319402",
      "ndc_label_name": "Capsule #0 Clear/Clear Veg Capsule",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779319801",
      "ndc_label_name": "Capsule #0 White/White Opq Veg Capsule",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779319802",
      "ndc_label_name": "Capsule #0 White/White Opq Veg Capsule",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779319809",
      "ndc_label_name": "Capsule #0 White/White Opq Veg Capsule",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779319509",
      "ndc_label_name": "Capsule #1 Clear/Clear Veg Capsule",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779319502",
      "ndc_label_name": "Capsule #1 Clear/Clear Veg Capsule",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779319702",
      "ndc_label_name": "Capsule #1 White/White Opq Veg Capsule",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779319701",
      "ndc_label_name": "Capsule #1 White/White Opq Veg Capsule",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779319709",
      "ndc_label_name": "Capsule #1 White/White Opq Veg Capsule",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552133702",
      "ndc_label_name": "Capsule 0 Clear DR CAPSULE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309402",
      "ndc_label_name": "Capsule Ezeefit #0 Clear CAPSULE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309401",
      "ndc_label_name": "Capsule Ezeefit #0 Clear CAPSULE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309409",
      "ndc_label_name": "Capsule Ezeefit #0 Clear CAPSULE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309501",
      "ndc_label_name": "Capsule Ezeefit #00 Clear CAPSULE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309502",
      "ndc_label_name": "Capsule Ezeefit #00 Clear CAPSULE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309509",
      "ndc_label_name": "Capsule Ezeefit #00 Clear CAPSULE",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779048803",
      "ndc_label_name": "Captopril POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452168104",
      "ndc_label_name": "Captopril Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779048805",
      "ndc_label_name": "Captopril POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452168101",
      "ndc_label_name": "Captopril Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452168102",
      "ndc_label_name": "Captopril POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779048806",
      "ndc_label_name": "Captopril POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779048804",
      "ndc_label_name": "Captopril POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552107202",
      "ndc_label_name": "Captopril POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552107205",
      "ndc_label_name": "Captopril POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102604",
      "ndc_label_name": "Captopril POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552107204",
      "ndc_label_name": "Captopril POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102603",
      "ndc_label_name": "Captopril POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452168103",
      "ndc_label_name": "Captopril Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927290700",
      "ndc_label_name": "Captopril POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102601",
      "ndc_label_name": "Captopril POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102602",
      "ndc_label_name": "Captopril POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407060301",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657093803",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143117401",
      "ndc_label_name": "Captopril TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722014401",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657073801",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241016301",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781808001",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547036610",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629873001",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69292052801",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657093810",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69292052850",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723094",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723060",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143117101",
      "ndc_label_name": "Captopril TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781805201",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722014101",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407060001",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143117110",
      "ndc_label_name": "Captopril TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904710561",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241016001",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723090",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781805210",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518330700",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657093503",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629872701",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723092",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241016010",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657093501",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73190002601",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687030411",
      "ndc_label_name": "Captopril TABLET 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547036310",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69292052210",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657073501",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687030421",
      "ndc_label_name": "Captopril TABLET 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69292052201",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143117210",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723191",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090184003",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723160",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143117201",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723130",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723190",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999010510",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999010500",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723192",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002043100",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722014201",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781806101",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904710661",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723194",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687031521",
      "ndc_label_name": "Captopril TABLET 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090429603",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547036410",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69292052410",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999010530",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241016101",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002043130",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781806110",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629133801",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687031511",
      "ndc_label_name": "Captopril TABLET 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407060110",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241016110",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999010560",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407060101",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002043160",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629133802",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289034430",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629133803",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657093601",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629872801",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289034490",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657073601",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657093603",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69292052401",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73190002701",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723260",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629254104",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781807501",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723291",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241016201",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143117301",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723230",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723292",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723294",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143117310",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407060210",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289021230",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407060201",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241016210",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723290",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999051130",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781807510",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289021290",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002108600",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629254102",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002108606",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73190002801",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999051160",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722014301",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002108603",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69292052610",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69292052601",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43547036510",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657073701",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657093710",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657093703",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629254103",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629254101",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629872901",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571082709",
      "ndc_label_name": "Captopril-hydroCHLOROthiazide Tablet 25-15 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571082809",
      "ndc_label_name": "Captopril-hydroCHLOROthiazide Tablet 25-25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571082909",
      "ndc_label_name": "Captopril-hydroCHLOROthiazide Tablet 50-15 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571083009",
      "ndc_label_name": "Captopril-hydroCHLOROthiazide Tablet 50-25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006434701",
      "ndc_label_name": "Capvaxive Solution Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006434702",
      "ndc_label_name": "Capvaxive Solution Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118997503",
      "ndc_label_name": "Carac Cream 0.5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00187520030",
      "ndc_label_name": "Carac Cream 0.5 % External",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959005230",
      "ndc_label_name": "Carafate Tablet 1 GM Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58914017110",
      "ndc_label_name": "Carafate TABLET 1 GM ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991258701",
      "ndc_label_name": "Caramel Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927216300",
      "ndc_label_name": "Caramel Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991258702",
      "ndc_label_name": "Caramel Flavor Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467013580",
      "ndc_label_name": "Caramel OS Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467013585",
      "ndc_label_name": "Caramel OS Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467013590",
      "ndc_label_name": "Caramel OS Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72467013595",
      "ndc_label_name": "Caramel OS Liquid",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927170300",
      "ndc_label_name": "Carbachol POWDER 99 %",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52276031205",
      "ndc_label_name": "Carbaglu Tablet Soluble 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52276031260",
      "ndc_label_name": "Carbaglu Tablet Soluble 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335292101",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672415101",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017011",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29033001912",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162202102",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162202106",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505280507",
      "ndc_label_name": "CarBAMazepine ER CAPSULE EXTENDED RELEASE 12 HOUR 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017013",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993040732",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904688504",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017111",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017113",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672415001",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629872101",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505280607",
      "ndc_label_name": "CarBAMazepine ER CAPSULE EXTENDED RELEASE 12 HOUR 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518317600",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29033002012",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518317601",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335300201",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162171402",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993040832",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335270601",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993040932",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672414901",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335270701",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017213",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29033000412",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629872001",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162171502",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505280707",
      "ndc_label_name": "CarBAMazepine ER CAPSULE EXTENDED RELEASE 12 HOUR 300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017211",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335300101",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781801601",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518317400",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668028401",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746078901",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832602211",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806027401",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571068001",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742025701",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518176902",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672412301",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714006301",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382055501",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407089501",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135092760",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518176900",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518176901",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518317401",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930007212",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714006401",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781598701",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518265300",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687058321",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832602311",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672412401",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668028501",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571068101",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806027501",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407089601",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930007312",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135092860",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687058311",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746079001",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742025801",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382055601",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518018100",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518333500",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518018101",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518018102",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518333501",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781598801",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71930007412",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672412501",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832602411",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687059421",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806027601",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746079101",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714006501",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668028601",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742025901",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135093060",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687059411",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571068201",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407089701",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382055701",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518154500",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779011405",
      "ndc_label_name": "CarBAMazepine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452170504",
      "ndc_label_name": "CarBAMazepine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779011408",
      "ndc_label_name": "CarBAMazepine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779011404",
      "ndc_label_name": "CarBAMazepine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102702",
      "ndc_label_name": "CarBAMazepine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779011409",
      "ndc_label_name": "CarBAMazepine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452170503",
      "ndc_label_name": "CarBAMazepine Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552065305",
      "ndc_label_name": "CarBAMazepine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452170501",
      "ndc_label_name": "CarBAMazepine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102701",
      "ndc_label_name": "CarBAMazepine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552065304",
      "ndc_label_name": "CarBAMazepine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452170502",
      "ndc_label_name": "CarBAMazepine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552065306",
      "ndc_label_name": "CarBAMazepine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552065307",
      "ndc_label_name": "CarBAMazepine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991102703",
      "ndc_label_name": "CarBAMazepine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927217600",
      "ndc_label_name": "CarBAMazepine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121189494",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135080253",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432012916",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121094794",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121189410",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121094705",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135080245",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672404709",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672404704",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954024010",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094000762",
      "ndc_label_name": "CarBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135080224",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094000759",
      "ndc_label_name": "CarBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094000859",
      "ndc_label_name": "CarBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094000862",
      "ndc_label_name": "CarBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135086759",
      "ndc_label_name": "carBAMazepine Suspension 200 MG/10ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856404701",
      "ndc_label_name": "carBAMazepine Suspension 200 MG/10ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135086724",
      "ndc_label_name": "carBAMazepine Suspension 200 MG/10ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904617261",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093010901",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723690",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668026805",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723628",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063032812",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093010910",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723620",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668026810",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353095330",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904617250",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300038210",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300038201",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353095353",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063032830",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723691",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999061601",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353095380",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452031220",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090444300",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090216100",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268016011",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353095360",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668026801",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999061660",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407021510",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518248904",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090574000",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090269700",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672400503",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090038400",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999061600",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090574003",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267027891",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518248905",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629875301",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672400502",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429003201",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090216103",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090038403",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084044401",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788782501",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335069101",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629929601",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505018300",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505018301",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268016015",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090216101",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788721001",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788782506",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610033680",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788721009",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084044411",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518090200",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629871501",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407021501",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788721002",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518224205",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189015730",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788782503",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788721006",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335069107",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788721003",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672400501",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452031232",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518224206",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788721008",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834022100",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205002590",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162170801",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788782509",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518224203",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518143600",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518245600",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518248902",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518224204",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610033630",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518248900",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518284100",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518248901",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518224201",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518248903",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518314600",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518284101",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518224202",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518284102",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610033660",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518224207",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610078280",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518224208",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834022101",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518248906",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518284103",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518314601",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610033653",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723528",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672404102",
      "ndc_label_name": "CarBAMazepine TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668027101",
      "ndc_label_name": "CarBAMazepine TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687047901",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723591",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429093405",
      "ndc_label_name": "CarBAMazepine TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440723590",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093077801",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904385461",
      "ndc_label_name": "CarBAMazepine TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629929201",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518242600",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518242602",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999078201",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629874301",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668027105",
      "ndc_label_name": "CarBAMazepine TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162257201",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518242601",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162257205",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672404101",
      "ndc_label_name": "CarBAMazepine TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687047911",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518143300",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518143301",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518404201",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672405001",
      "ndc_label_name": "carBAMazepine Tablet Chewable 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452807701",
      "ndc_label_name": "Carbamide Peroxide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927147600",
      "ndc_label_name": "Carbamide Peroxide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452807702",
      "ndc_label_name": "Carbamide Peroxide POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452807703",
      "ndc_label_name": "Carbamide Peroxide Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54092017112",
      "ndc_label_name": "Carbatrol Capsule Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54092017212",
      "ndc_label_name": "Carbatrol Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54092017312",
      "ndc_label_name": "Carbatrol Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779195309",
      "ndc_label_name": "Carbazochrome POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779195302",
      "ndc_label_name": "Carbazochrome POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779195301",
      "ndc_label_name": "Carbazochrome POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779195305",
      "ndc_label_name": "Carbazochrome POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779020203",
      "ndc_label_name": "Carbidopa Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779020205",
      "ndc_label_name": "Carbidopa Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779020204",
      "ndc_label_name": "Carbidopa Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779020208",
      "ndc_label_name": "Carbidopa Anhydrous POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927248000",
      "ndc_label_name": "Carbidopa POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452169205",
      "ndc_label_name": "Carbidopa Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452169201",
      "ndc_label_name": "Carbidopa Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452169202",
      "ndc_label_name": "Carbidopa Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284803",
      "ndc_label_name": "Carbidopa POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452169203",
      "ndc_label_name": "Carbidopa Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552110202",
      "ndc_label_name": "Carbidopa POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284802",
      "ndc_label_name": "Carbidopa POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452169204",
      "ndc_label_name": "Carbidopa Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991284801",
      "ndc_label_name": "Carbidopa POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552110204",
      "ndc_label_name": "Carbidopa POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43386098001",
      "ndc_label_name": "Carbidopa Tablet 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43975022010",
      "ndc_label_name": "Carbidopa Tablet 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629919301",
      "ndc_label_name": "Carbidopa Tablet 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799012301",
      "ndc_label_name": "Carbidopa TABLET 25 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629193201",
      "ndc_label_name": "Carbidopa Tablet 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407031401",
      "ndc_label_name": "Carbidopa Tablet 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682020025",
      "ndc_label_name": "Carbidopa Tablet 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714006701",
      "ndc_label_name": "Carbidopa Tablet 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710122101",
      "ndc_label_name": "Carbidopa Tablet 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781033201",
      "ndc_label_name": "Carbidopa Tablet 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651014601",
      "ndc_label_name": "Carbidopa Tablet 25 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710213901",
      "ndc_label_name": "Carbidopa-Levodopa ER Capsule Extended Release 23.75-95 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710214001",
      "ndc_label_name": "Carbidopa-Levodopa ER Capsule Extended Release 36.25-145 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710214101",
      "ndc_label_name": "Carbidopa-Levodopa ER Capsule Extended Release 48.75-195 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710214201",
      "ndc_label_name": "Carbidopa-Levodopa ER Capsule Extended Release 61.25-245 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228046001",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228046010",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079097801",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771046001",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729007801",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084028101",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378008801",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162219401",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079097820",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219203301",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729007817",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001017100",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353032709",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084028111",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756046188",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888015501",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888015530",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228046101",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084028201",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756045788",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228046110",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079092301",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378009401",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729007901",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001017200",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079092320",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084028211",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162219301",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544067260",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544067251",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729007917",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67544067280",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888015630",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771046101",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219203401",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888015601",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093970101",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722038105",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378007801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356062860",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093970105",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228253850",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999099860",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010600",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291046501",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629235501",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090718601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045705",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722038101",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291046550",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817039010",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010605",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291047101",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087711",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407016601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407016605",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090718600",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087700",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862085505",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291047150",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087764",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862007801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651045601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817039050",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087790",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68002010004",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862007805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367033801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862085501",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087772",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367033805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087778",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756051788",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 10-100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756051713",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 10-100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68002010002",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087760",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087730",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087755",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907002201",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228253910",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904734761",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093970210",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904750161",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291047201",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093970205",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090341901",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093970201",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291046610",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722038205",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904725761",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291046601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079075620",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228253950",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090596901",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353060460",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090672700",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353020260",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722038201",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353051060",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817039100",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378008501",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090658002",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090658001",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090749801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353020280",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291047210",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353051080",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817039110",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904623761",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090672500",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407016701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862085605",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090658003",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353060480",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090596903",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629235701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722038210",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090749803",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817039150",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862085610",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862007910",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079075601",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090749802",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518290901",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090341902",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090749900",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687066101",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651045701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756051818",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407016705",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862007905",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087878",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090341903",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756051888",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687066111",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087811",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862007901",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739010810",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610057980",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090385701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756051813",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084009301",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087872",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087860",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862085601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367033910",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087890",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090596902",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367033905",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518290900",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610026980",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629235601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610057960",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045810",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087830",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518290902",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084009311",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651045705",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010700",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907002005",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087800",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367033901",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010705",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610026960",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610064760",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518325000",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610066480",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610066460",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907002010",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087855",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087864",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610064780",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907002001",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093970310",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093970301",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228254010",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904623861",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904754961",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093970305",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228254096",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291046701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407016805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291048801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291046710",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045905",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367034001",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228254050",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378113301",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291048810",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756051913",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862008001",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407016801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862085801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087990",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722038305",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722038301",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862085810",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687083601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817039200",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756098502",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356062960",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722038310",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817039210",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087911",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228045901",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687083611",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756051988",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629235801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862085805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999099960",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084009401",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010800",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651045801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629915401",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084009411",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518290800",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907002101",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817039250",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087900",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367034005",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087955",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651045805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087964",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087930",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907002105",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756098501",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087960",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087972",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205087978",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571015701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet Dispersible 10-100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335018688",
      "ndc_label_name": "Carbidopa-Levodopa Tablet Dispersible 10-100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571015801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet Dispersible 25-100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335018788",
      "ndc_label_name": "Carbidopa-Levodopa Tablet Dispersible 25-100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571015901",
      "ndc_label_name": "Carbidopa-Levodopa Tablet Dispersible 25-250 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335018888",
      "ndc_label_name": "Carbidopa-Levodopa Tablet Dispersible 25-250 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335000188",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 12.5-50-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781561301",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 12.5-50-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571068901",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 12.5-50-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679078204",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 12.5-50-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781562501",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 18.75-75-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571069001",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 18.75-75-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679078304",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 18.75-75-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335000288",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 18.75-75-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571069101",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 25-100-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679078404",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 25-100-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378830201",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 25-100-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781563701",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 25-100-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335000388",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 25-100-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781564101",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 31.25-125-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378830301",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 31.25-125-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571069201",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 31.25-125-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335000488",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 31.25-125-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679078504",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 31.25-125-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571069301",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 37.5-150-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679078604",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 37.5-150-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781565401",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 37.5-150-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335000588",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 37.5-150-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571069401",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 50-200-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335000688",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 50-200-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781566901",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 50-200-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679078704",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 50-200-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378830501",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 50-200-200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927282800",
      "ndc_label_name": "Carbimazole POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62542010105",
      "ndc_label_name": "Carbinoxamine Maleate ER Suspension Extended Release 4 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991033404",
      "ndc_label_name": "Carbinoxamine Maleate Solution 4 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64950024316",
      "ndc_label_name": "Carbinoxamine Maleate Solution 4 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64950024304",
      "ndc_label_name": "Carbinoxamine Maleate Solution 4 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64950021101",
      "ndc_label_name": "Carbinoxamine Maleate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44523082501",
      "ndc_label_name": "Carbinoxamine Maleate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991033301",
      "ndc_label_name": "Carbinoxamine Maleate Tablet 4 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69067024020",
      "ndc_label_name": "Carbinoxamine Maleate Tablet 6 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73684011060",
      "ndc_label_name": "Carbinoxamine Maleate Tablet 6 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315023901",
      "ndc_label_name": "Carbinoxamine Maleate Tablet 6 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80705012030",
      "ndc_label_name": "Carbinoxamine Maleate Tablet 6 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552072704",
      "ndc_label_name": "Carbohol 940 GEL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552072707",
      "ndc_label_name": "Carbohol 940 GEL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552072705",
      "ndc_label_name": "Carbohol 940 GEL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552072708",
      "ndc_label_name": "Carbohol 940 GEL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927227300",
      "ndc_label_name": "Carbomer 934P POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452170601",
      "ndc_label_name": "Carbomer 934P Resin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452170602",
      "ndc_label_name": "Carbomer 934P Resin POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452170603",
      "ndc_label_name": "Carbomer 934P Resin Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991315303",
      "ndc_label_name": "Carbomer 940 NF Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991315301",
      "ndc_label_name": "Carbomer 940 NF Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991315302",
      "ndc_label_name": "Carbomer 940 NF Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927309400",
      "ndc_label_name": "Carbomer 940 POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452170702",
      "ndc_label_name": "Carbomer 940 Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452170701",
      "ndc_label_name": "Carbomer 940 Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452170703",
      "ndc_label_name": "Carbomer 940 Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452170801",
      "ndc_label_name": "Carbomer 941 Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452170802",
      "ndc_label_name": "Carbomer 941 Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452170803",
      "ndc_label_name": "Carbomer 941 Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927525500",
      "ndc_label_name": "Carbomer 980 NF Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991280402",
      "ndc_label_name": "Carbomer Aqueous GEL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991280401",
      "ndc_label_name": "Carbomer Aqueous GEL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552010704",
      "ndc_label_name": "Carbomer Homopolymer Type C POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991280302",
      "ndc_label_name": "Carbomer Hydroalcoholic GEL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991280301",
      "ndc_label_name": "Carbomer Hydroalcoholic GEL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991134504",
      "ndc_label_name": "Carbopol 940 NF POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991134503",
      "ndc_label_name": "Carbopol 940 NF POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991134502",
      "ndc_label_name": "Carbopol 940 NF POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592003601",
      "ndc_label_name": "Carbopol 940 Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592003611",
      "ndc_label_name": "Carbopol 940 Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592003645",
      "ndc_label_name": "Carbopol 940 Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592003605",
      "ndc_label_name": "Carbopol 940 Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927123500",
      "ndc_label_name": "Carboxymethylcellulose Sodium GRANULES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452174001",
      "ndc_label_name": "Carboxymethylcellulose Sodium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452173003",
      "ndc_label_name": "Carboxymethylcellulose Sodium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927107700",
      "ndc_label_name": "Carboxymethylcellulose Sodium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452173002",
      "ndc_label_name": "Carboxymethylcellulose Sodium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452175001",
      "ndc_label_name": "Carboxymethylcellulose Sodium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452174003",
      "ndc_label_name": "Carboxymethylcellulose Sodium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452173001",
      "ndc_label_name": "Carboxymethylcellulose Sodium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452233701",
      "ndc_label_name": "Carboxymethylcellulose Sodium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452175002",
      "ndc_label_name": "Carboxymethylcellulose Sodium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452175003",
      "ndc_label_name": "Carboxymethylcellulose Sodium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452174000",
      "ndc_label_name": "Carboxymethylcellulose Sodium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452233702",
      "ndc_label_name": "Carboxymethylcellulose Sodium Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991102903",
      "ndc_label_name": "Carboxymethylcellulose Sodium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552009906",
      "ndc_label_name": "Carboxymethylcellulose Sodium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552009905",
      "ndc_label_name": "Carboxymethylcellulose Sodium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927180000",
      "ndc_label_name": "Carboxymethylcellulose Sodium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71085008007",
      "ndc_label_name": "Carbzah Solution 4 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991143001",
      "ndc_label_name": "Cardamom OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10122031401",
      "ndc_label_name": "Cardene IV Solution 20-4.8 MG/200ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10122031410",
      "ndc_label_name": "Cardene IV Solution 20-4.8 MG/200ML-% Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00049241010",
      "ndc_label_name": "Cardura Tablet 1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00049275066",
      "ndc_label_name": "Cardura Tablet 1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58151007401",
      "ndc_label_name": "Cardura Tablet 1 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00049251210",
      "ndc_label_name": "Cardura Tablet 2 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00049276066",
      "ndc_label_name": "Cardura Tablet 2 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00049261410",
      "ndc_label_name": "Cardura Tablet 4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58151007601",
      "ndc_label_name": "Cardura Tablet 4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00049277066",
      "ndc_label_name": "Cardura Tablet 4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00049278066",
      "ndc_label_name": "Cardura Tablet 8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00049271610",
      "ndc_label_name": "Cardura Tablet 8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00049204010",
      "ndc_label_name": "Cardura XL Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58151007893",
      "ndc_label_name": "Cardura XL Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00049271030",
      "ndc_label_name": "Cardura XL Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00049272030",
      "ndc_label_name": "Cardura XL Tablet Extended Release 24 Hour 8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00049208010",
      "ndc_label_name": "Cardura XL Tablet Extended Release 24 Hour 8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58151007993",
      "ndc_label_name": "Cardura XL Tablet Extended Release 24 Hour 8 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227021805",
      "ndc_label_name": "Carepoint Poly Hub Needle 18G X 1\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227021815",
      "ndc_label_name": "Carepoint Poly Hub Needle 18G X 1-1/2\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227022115",
      "ndc_label_name": "Carepoint Poly Hub Needle 21G X 1-1/2\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227022205",
      "ndc_label_name": "Carepoint Poly Hub Needle 22G X 1\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227022215",
      "ndc_label_name": "Carepoint Poly Hub Needle 22G X 1-1/2\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227022305",
      "ndc_label_name": "Carepoint Poly Hub Needle 23G X 1\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227022315",
      "ndc_label_name": "Carepoint Poly Hub Needle 23G X 1-1/2\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227022505",
      "ndc_label_name": "Carepoint Poly Hub Needle 25G X 1\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227022515",
      "ndc_label_name": "Carepoint Poly Hub Needle 25G X 1-1/2\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227022555",
      "ndc_label_name": "Carepoint Poly Hub Needle 25G X 5/8\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227022705",
      "ndc_label_name": "Carepoint Poly Hub Needle 27G X 1/2\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227023005",
      "ndc_label_name": "Carepoint Poly Hub Needle 30G X 1/2\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227022306",
      "ndc_label_name": "Carepoint Precision Poly Hub 23G X 1\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227087035",
      "ndc_label_name": "CarePoint Safety 1st Needle 23G X 1\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227087045",
      "ndc_label_name": "CarePoint Safety 1st Needle 23G X 1-1/2\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227087015",
      "ndc_label_name": "CarePoint Safety 1st Needle 25G X 1\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227087025",
      "ndc_label_name": "CarePoint Safety 1st Needle 25G X 1-1/2\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227087005",
      "ndc_label_name": "CarePoint Safety 1st Needle 25G X 5/8\"",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227082025",
      "ndc_label_name": "CarePoint Safety1st Syr/Needle 23G X 1\" 3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227082015",
      "ndc_label_name": "CarePoint Safety1st Syr/Needle 25G X 1\" 3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227082005",
      "ndc_label_name": "CarePoint Safety1st Syr/Needle 25G X 5/8\" 3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227004655",
      "ndc_label_name": "Carepoint Syringe Catheter Tip 60 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227004016",
      "ndc_label_name": "Carepoint Syringe Luer Lock 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227004015",
      "ndc_label_name": "Carepoint Syringe Luer Lock 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227004105",
      "ndc_label_name": "Carepoint Syringe Luer Lock 10 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227004106",
      "ndc_label_name": "Carepoint Syringe Luer Lock 10 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227004205",
      "ndc_label_name": "Carepoint Syringe Luer Lock 20 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227005315",
      "ndc_label_name": "Carepoint Syringe Luer Lock 20G X 1\" 3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227503015",
      "ndc_label_name": "Carepoint Syringe Luer Lock 20G X 1\" 3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227005325",
      "ndc_label_name": "Carepoint Syringe Luer Lock 20G X 1-1/2\" 3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227005386",
      "ndc_label_name": "Carepoint Syringe Luer Lock 23G X 1-1/2\" 3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227005385",
      "ndc_label_name": "Carepoint Syringe Luer Lock 23G X 1-1/2\" 3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227005395",
      "ndc_label_name": "Carepoint Syringe Luer Lock 25G X 1\" 3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227005306",
      "ndc_label_name": "Carepoint Syringe Luer Lock 25G X 1-1/2\" 3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227503095",
      "ndc_label_name": "Carepoint Syringe Luer Lock 25G X 1-1/2\" 3 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227004305",
      "ndc_label_name": "Carepoint Syringe Luer Lock 30 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227004055",
      "ndc_label_name": "Carepoint Syringe Luer Lock 5 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227004605",
      "ndc_label_name": "Carepoint Syringe Luer Lock 60 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227004606",
      "ndc_label_name": "Carepoint Syringe Luer Lock 60 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227001015",
      "ndc_label_name": "Carepoint Syringe Luer Slip 1 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "86227001605",
      "ndc_label_name": "Carepoint Syringe Luer Slip 60 ML",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71863011460",
      "ndc_label_name": "Carglumic Acid Tablet Soluble 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35573045960",
      "ndc_label_name": "Carglumic Acid Tablet Soluble 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452176102",
      "ndc_label_name": "Carisoprodol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991217303",
      "ndc_label_name": "Carisoprodol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452176104",
      "ndc_label_name": "Carisoprodol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452176101",
      "ndc_label_name": "Carisoprodol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927316900",
      "ndc_label_name": "Carisoprodol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452176103",
      "ndc_label_name": "Carisoprodol Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991217301",
      "ndc_label_name": "Carisoprodol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991217302",
      "ndc_label_name": "Carisoprodol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991217304",
      "ndc_label_name": "Carisoprodol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991217307",
      "ndc_label_name": "Carisoprodol POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571078001",
      "ndc_label_name": "Carisoprodol Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52536068210",
      "ndc_label_name": "Carisoprodol TABLET 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335270801",
      "ndc_label_name": "Carisoprodol Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51525590101",
      "ndc_label_name": "Carisoprodol Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033020701",
      "ndc_label_name": "Carisoprodol Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862069301",
      "ndc_label_name": "Carisoprodol TABLET 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700090730",
      "ndc_label_name": "Carisoprodol Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367041901",
      "ndc_label_name": "Carisoprodol Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629914401",
      "ndc_label_name": "Carisoprodol Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980038001",
      "ndc_label_name": "Carisoprodol Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714051001",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082490",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571078101",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723820",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723840",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591551301",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723830",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082430",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082415",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999006401",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082414",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591551310",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723891",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033021401",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723890",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999006418",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353010253",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999006407",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090304809",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714051003",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714051002",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353010260",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591551305",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999006460",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353010270",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090253009",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436258202",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999006406",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353010230",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090277105",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571078110",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090253003",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090253008",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090321108",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002620",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090321109",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228010901",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090323205",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571078150",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436045103",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090321100",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436258203",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002630",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090323200",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436070504",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090595509",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090253000",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436045104",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090321103",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436258204",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002652",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090595500",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436109001",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436045101",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090595508",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436070501",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090595305",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002606",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289004930",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090595503",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436109003",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436045102",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228010910",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742065601",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436070503",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289004920",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289004960",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228010905",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002600",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436070502",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436109002",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002628",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002621",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289004921",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700095430",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742065605",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002603",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436109004",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002610",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002656",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002640",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077030",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003930",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002615",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002614",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436258201",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002632",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289004940",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700095460",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118017409",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919076872",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002645",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002624",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002612",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002690",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700095490",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442045110",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187011360",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919087872",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002680",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002650",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002625",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002035630",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442045105",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003920",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187011390",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919097990",
      "ndc_label_name": "Carisoprodol TABLET 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289004910",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289004924",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002660",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289004901",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003940",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919087860",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078690",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561012701",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289004915",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700083601",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289004914",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289004990",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003960",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267004345",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629130810",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629470701",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700083660",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429050810",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289004998",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657064501",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003972",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584011190",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629470703",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629470702",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700095401",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919076830",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700083630",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657064550",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919097930",
      "ndc_label_name": "Carisoprodol TABLET 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518261800",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629470704",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629847701",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118017407",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919076890",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700083690",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429050801",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919097960",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518280001",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629847801",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367042001",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003990",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919087890",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118017403",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760039790",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135024112",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043030",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862015805",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584011150",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367042005",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078630",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118017406",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760070530",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187011372",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061730",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267004356",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518379201",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335069301",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078660",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657064510",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442045101",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629241601",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061770",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071200406",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335069300",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335069306",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561012702",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919087830",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919076860",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267004315",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162152401",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584011110",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009753",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335069307",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629116701",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187011330",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629847901",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267100700",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162252500",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205024120",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610053170",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335120307",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629116901",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629116801",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267004384",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518280000",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031072",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205033930",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162152400",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043060",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629914501",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267004312",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518261801",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076175",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862015801",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335069304",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162152405",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061760",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862015899",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205024190",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518313100",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162192801",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267004340",
      "ndc_label_name": "Carisoprodol TABLET 350 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610053130",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031030",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076130",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205024130",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205070490",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335069309",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162252501",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205033990",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189038672",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189038630",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076170",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335069302",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335069305",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009730",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162252502",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335069303",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001614",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001615",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001901",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335069308",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335120303",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009770",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047798",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335120305",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001990",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001630",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001998",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335120309",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043053",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043070",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018295",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335301801",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019014",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019030",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018298",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009760",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031090",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076153",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019098",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610053153",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189038690",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047730",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047790",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610053160",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018201",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031060",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047795",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061753",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047701",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420064630",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029103",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076160",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420064660",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001995",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029101",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018290",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420064601",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029102",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420064690",
      "ndc_label_name": "Carisoprodol Tablet 350 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086890",
      "ndc_label_name": "Carisoprodol-Aspirin-Codeine Tablet 200-325-16 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959086800",
      "ndc_label_name": "Carisoprodol-Aspirin-Codeine Tablet 200-325-16 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742025601",
      "ndc_label_name": "Carisoprodol-Aspirin-Codeine Tablet 200-325-16 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959086860",
      "ndc_label_name": "Carisoprodol-Aspirin-Codeine Tablet 200-325-16 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452176002",
      "ndc_label_name": "Carmine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452176001",
      "ndc_label_name": "Carmine POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729054863",
      "ndc_label_name": "Carmustine Solution Reconstituted 300 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729054601",
      "ndc_label_name": "Carmustine Solution Reconstituted 300 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729054563",
      "ndc_label_name": "Carmustine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729054305",
      "ndc_label_name": "Carmustine Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927182500",
      "ndc_label_name": "Carnauba Wax FLAKES",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779030609",
      "ndc_label_name": "Carnitine (L) POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779030605",
      "ndc_label_name": "Carnitine (L) POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779276305",
      "ndc_label_name": "Carnitine (L) POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779030604",
      "ndc_label_name": "Carnitine (L) POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779276308",
      "ndc_label_name": "Carnitine (L) POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779030608",
      "ndc_label_name": "Carnitine (L) POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779276303",
      "ndc_label_name": "Carnitine (L) POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779276304",
      "ndc_label_name": "Carnitine (L) POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779276309",
      "ndc_label_name": "Carnitine (L) POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54482014801",
      "ndc_label_name": "Carnitor SF Solution 1 GM/10ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54482014802",
      "ndc_label_name": "Carnitor SF Solution 1 GM/10ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54482014508",
      "ndc_label_name": "Carnitor Solution 1 GM/10ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54482014509",
      "ndc_label_name": "Carnitor Solution 1 GM/10ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54482014701",
      "ndc_label_name": "Carnitor Solution 200 MG/ML Intravenous",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54482014407",
      "ndc_label_name": "Carnitor TABLET 330 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927279500",
      "ndc_label_name": "Carnosine L POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46287002050",
      "ndc_label_name": "CaroSpir Suspension 25 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46287002001",
      "ndc_label_name": "CaroSpir Suspension 25 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46287002004",
      "ndc_label_name": "CaroSpir Suspension 25 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927439500",
      "ndc_label_name": "Carrageenan POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314023805",
      "ndc_label_name": "Carteolol HCl SOLUTION 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314023810",
      "ndc_label_name": "Carteolol HCl SOLUTION 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314023815",
      "ndc_label_name": "Carteolol HCl SOLUTION 1 % Ophthalmic",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090305101",
      "ndc_label_name": "Cartia XT Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62037059790",
      "ndc_label_name": "Cartia XT CAPSULE EXTENDED RELEASE 24 HOUR 120 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62037059705",
      "ndc_label_name": "Cartia XT CAPSULE EXTENDED RELEASE 24 HOUR 120 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090305100",
      "ndc_label_name": "Cartia XT Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629823201",
      "ndc_label_name": "Cartia XT Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335122301",
      "ndc_label_name": "Cartia XT Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62037059890",
      "ndc_label_name": "Cartia XT CAPSULE EXTENDED RELEASE 24 HOUR 180 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62037059805",
      "ndc_label_name": "Cartia XT CAPSULE EXTENDED RELEASE 24 HOUR 180 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62037059990",
      "ndc_label_name": "Cartia XT CAPSULE EXTENDED RELEASE 24 HOUR 240 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62037059905",
      "ndc_label_name": "Cartia XT CAPSULE EXTENDED RELEASE 24 HOUR 240 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62037060005",
      "ndc_label_name": "Cartia XT CAPSULE EXTENDED RELEASE 24 HOUR 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62037060090",
      "ndc_label_name": "Cartia XT CAPSULE EXTENDED RELEASE 24 HOUR 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115124808",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407005030",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714022701",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335030801",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291047930",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505367803",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69784071313",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505471303",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664066383",
      "ndc_label_name": "Carvedilol Phosphate ER CAPSULE EXTENDED RELEASE 24 HOUR 10 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69784071413",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291048030",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115124908",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407005130",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505367903",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714022801",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664066483",
      "ndc_label_name": "Carvedilol Phosphate ER CAPSULE EXTENDED RELEASE 24 HOUR 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335970701",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505471403",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69784071513",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505471503",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714022901",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115125008",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664066583",
      "ndc_label_name": "Carvedilol Phosphate ER CAPSULE EXTENDED RELEASE 24 HOUR 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291048130",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407005230",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505368003",
      "ndc_label_name": "Carvedilol Phosphate ER CAPSULE EXTENDED RELEASE 24 HOUR 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629963401",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 40 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115125108",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407005330",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291048230",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714023001",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664066683",
      "ndc_label_name": "Carvedilol Phosphate ER CAPSULE EXTENDED RELEASE 24 HOUR 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69784071613",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629963501",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505368103",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505471603",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629879401",
      "ndc_label_name": "Carvedilol Phosphate ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781522301",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063505",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093729505",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090106701",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063012590",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063501",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378363305",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093729501",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090106703",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016060",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378363301",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090255502",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016053",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016030",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090106700",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063012593",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090106704",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016070",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904630261",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079093101",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353087460",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111025405",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090255501",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090207901",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090207900",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353087480",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904730761",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760023460",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919072890",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014401",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090255504",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090207903",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090687800",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090255500",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016080",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015103",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629366902",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462016401",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187044790",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090207904",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407004101",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090255503",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353087430",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462016405",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645035159",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788753901",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015100",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407004105",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919072830",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760049460",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079093120",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788815106",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335036806",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629366903",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382009405",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187044730",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629366901",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382009401",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111025401",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518035600",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006660",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788815103",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788753909",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788753903",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788753906",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788815109",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014405",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518035601",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189037230",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335036802",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335036804",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934051590",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934070730",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888050102",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788815101",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934070790",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789053793",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385011250",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934051530",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003601",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006680",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009012705",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003600",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003605",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804022590",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378363405",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063012993",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093729601",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093729605",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063701",
      "ndc_label_name": "Carvedilol TABLET 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353013380",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378363401",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904630361",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904730861",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353013360",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781522401",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063705",
      "ndc_label_name": "Carvedilol TABLET 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353013353",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090784903",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356052690",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353013330",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356052600",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090106903",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211904",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063012930",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090106900",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079093201",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083209",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090417104",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063012960",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090417100",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090417101",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090106904",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090106901",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382009501",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083260",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090784904",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083280",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111025501",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111025505",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211901",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211900",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645049659",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090784901",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407004205",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090211903",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919073030",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919073060",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090417103",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015203",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681903",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090785000",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919053390",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090572600",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014505",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919073090",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079093220",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681906",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681909",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407004201",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014501",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090784900",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518182600",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187040930",
      "ndc_label_name": "Carvedilol TABLET 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681908",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788791006",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788791003",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154567600",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681901",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760023560",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335027304",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462016501",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788791009",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788823109",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788823101",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187040960",
      "ndc_label_name": "Carvedilol TABLET 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003700",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462016505",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006760",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518182601",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934040630",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518238900",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789044093",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015200",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009012805",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518182602",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006780",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335027303",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934065330",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934075990",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888050202",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071085630",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789044090",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003701",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804013860",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003705",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385011301",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385011350",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804018390",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382009505",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804013890",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788791001",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888050201",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378363101",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781522101",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093005101",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093005105",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063301",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063012660",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063012693",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353013253",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904730561",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904630061",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378363105",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090106202",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111025201",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083753",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090185601",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090185600",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063305",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083780",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090106201",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090106203",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462016205",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090106200",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090206600",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079077101",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083760",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079077120",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382009201",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090185603",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518137703",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090206601",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090206603",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407003905",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090206602",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462016201",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518137702",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187057090",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189065390",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090694900",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111025205",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919021930",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407003901",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006280",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610013260",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187094160",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804019160",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788745803",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919021990",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015303",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014205",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009012505",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610013280",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518137700",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015300",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788825206",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014201",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788745808",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382009205",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888049901",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788745801",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518137701",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788745806",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888049902",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788825209",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788745809",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788825201",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385011050",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518137704",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789041190",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006253",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788825203",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003401",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003400",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788825208",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518058201",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006260",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610013253",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003405",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385011001",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781522201",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904630161",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378363201",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378363205",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760053260",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093013501",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093013505",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904730661",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090217504",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353015653",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063405",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356051218",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187042430",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079093020",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063401",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353015660",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111025305",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090106401",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063083360",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083880",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187094660",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407004005",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353015680",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083860",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760037660",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090217503",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083830",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090217500",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382009305",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700081918",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090674204",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090686500",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760058260",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090674201",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353083853",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090217501",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788817703",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084085411",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462016301",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079093001",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187094690",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919098430",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090674203",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090674200",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042601",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681708",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788760308",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760023360",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629366803",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919098490",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015400",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407004001",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335056101",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681709",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385011101",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014305",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681706",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629366802",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001015403",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111025301",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335056102",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788760309",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788760303",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382009301",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788788309",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014301",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788788301",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700081990",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006353",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788817709",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042600",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462016305",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042603",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071084130",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003501",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629366801",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934068660",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006380",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006330",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681701",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610006360",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68645035059",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003505",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084085401",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788788303",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788760306",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788788306",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788681703",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518042604",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788817706",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934051760",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788760301",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789043160",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788978903",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009012605",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788788308",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335056104",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888050001",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888003500",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888050002",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76385011150",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840578305",
      "ndc_label_name": "Cashew Nut (Diagnostic) Solution 1:20 Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559068030",
      "ndc_label_name": "Casodex Tablet 50 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923061450",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781342194",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323035610",
      "ndc_label_name": "Caspofungin Acetate SOLUTION RECONSTITUTED 50 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323035601",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860010610",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266010601",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611070001",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781342101",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021019410",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 50 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266010701",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 70 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781342301",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 70 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323035801",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 70 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781342394",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 70 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021019510",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 70 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923061370",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 70 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323035810",
      "ndc_label_name": "Caspofungin Acetate SOLUTION RECONSTITUTED 70 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860010710",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 70 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611070201",
      "ndc_label_name": "Caspofungin Acetate Solution Reconstituted 70 MG Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779091001",
      "ndc_label_name": "Castor Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452183001",
      "ndc_label_name": "Castor Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00395051592",
      "ndc_label_name": "Castor Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00395051596",
      "ndc_label_name": "Castor Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00395051394",
      "ndc_label_name": "Castor Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927286600",
      "ndc_label_name": "Castor Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592001743",
      "ndc_label_name": "Castor Oil Oil",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00395051516",
      "ndc_label_name": "Castor Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452183002",
      "ndc_label_name": "Castor Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552041408",
      "ndc_label_name": "Castor Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552041406",
      "ndc_label_name": "Castor Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452183003",
      "ndc_label_name": "Castor Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991122501",
      "ndc_label_name": "Castor Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779091008",
      "ndc_label_name": "Castor Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592001732",
      "ndc_label_name": "Castor Oil Oil",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552041404",
      "ndc_label_name": "Castor Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60592001770",
      "ndc_label_name": "Castor Oil Oil",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991122502",
      "ndc_label_name": "Castor Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452184002",
      "ndc_label_name": "Castor Oil Sulfated OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452184001",
      "ndc_label_name": "Castor Oil Sulfated OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "22840010105",
      "ndc_label_name": "Cat Hair Extract Solution 10000 BAU/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840010102",
      "ndc_label_name": "Cat Hair Extract Solution 10000 BAU/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840010104",
      "ndc_label_name": "Cat Hair Extract Solution 10000 BAU/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840010002",
      "ndc_label_name": "Cat Hair Extract Solution 5000 BAU/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "22840010004",
      "ndc_label_name": "Cat Hair Extract Solution 5000 BAU/ML Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73684015060",
      "ndc_label_name": "Cataflam Tablet 50 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00395052191",
      "ndc_label_name": "Catnip Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "61958090101",
      "ndc_label_name": "Cayston Solution Reconstituted 75 MG Inhalation",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862023801",
      "ndc_label_name": "Caziant Tablet 0.1/0.125/0.15 -0.025 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862023803",
      "ndc_label_name": "Caziant Tablet 0.1/0.125/0.15 -0.025 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452184504",
      "ndc_label_name": "Cedar Leaf Oil Oil",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927247300",
      "ndc_label_name": "Cedar Leaf Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452184503",
      "ndc_label_name": "Cedar Leaf Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452184502",
      "ndc_label_name": "Cedar Leaf Oil OIL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00395203491",
      "ndc_label_name": "Cedarwood Oil Oil",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52959036700",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036721",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036714",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036715",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021130",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036730",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442017130",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036720",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036740",
      "ndc_label_name": "Cefaclor Capsule 250 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036821",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090051802",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036840",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090160200",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442017230",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036820",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036810",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036814",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036830",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090160202",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959036828",
      "ndc_label_name": "Cefaclor Capsule 500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093108701",
      "ndc_label_name": "Cefaclor ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23594012501",
      "ndc_label_name": "Cefaclor Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23594037501",
      "ndc_label_name": "Cefaclor Suspension Reconstituted 375 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063055320",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093319601",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714038801",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724202",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093319653",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959042820",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063055328",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714038802",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090058000",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959042814",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063059520",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063055314",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724206",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959042830",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999002110",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090058001",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090605001",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959042815",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959042818",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090191502",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724210",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788641601",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090058002",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635600",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090605002",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237009650",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289058928",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635602",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063055310",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788748401",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090605000",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002022920",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004514",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425040003",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004520",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180018001",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063059528",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788748402",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629422301",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629422501",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788641602",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518253801",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004530",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788748403",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999002114",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189010320",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008501",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629798801",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788826103",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189044520",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788641604",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934008194",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090191500",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189050606",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004524",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629825301",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005694",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425019803",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788826102",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189050620",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959042804",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425043202",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788748406",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004510",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959042810",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788748404",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788847903",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788847902",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959042816",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934008191",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189044506",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189010306",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959042828",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425019801",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425040002",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425019802",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002022914",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425040001",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425043203",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237009601",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629422401",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008550",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004528",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180018008",
      "ndc_label_name": "Cefadroxil CAPSULE 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788641603",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788641606",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518253800",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934005691",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425043201",
      "ndc_label_name": "Cefadroxil Capsule 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714038901",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237009701",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008301",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180018102",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039002",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008475",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180018202",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180018203",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237009801",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039001",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008401",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237009875",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093405953",
      "ndc_label_name": "Cefadroxil Tablet 1 GM Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010110",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781345170",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781345196",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010167",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143992490",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143926201",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090425600",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505624300",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567070725",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567012025",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614205",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572005525",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205067901",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143926225",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189058401",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323023710",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572005501",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518304700",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090271400",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518304701",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614200",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505624304",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330001525",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409258501",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409258511",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010299",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 10 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143926110",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 10 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998391",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 10 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572005610",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 10 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143926101",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 10 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572005601",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 10 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998303",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 10 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781345295",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 10 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323023861",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 10 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781345246",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 10 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505624400",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 10 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614304",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 10 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010269",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 10 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567070810",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 10 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323023801",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 10 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505624404",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 10 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614300",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 10 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505623100",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505623105",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567084025",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143913925",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143913901",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567084001",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505626600",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 3 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505626605",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 3 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567084501",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 3 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143914001",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 3 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143914025",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 3 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567084525",
      "ndc_label_name": "ceFAZolin Sodium Solution Reconstituted 3 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010066",
      "ndc_label_name": "CeFAZolin Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781345070",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567070625",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010010",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781345095",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143992390",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330001425",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323023610",
      "ndc_label_name": "CeFAZolin Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338350341",
      "ndc_label_name": "CeFAZolin Sodium-Dextrose Solution 1-4 GM/50ML-% Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264310311",
      "ndc_label_name": "CeFAZolin Sodium-Dextrose Solution Reconstituted 1-4 GM-%(50ML) Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264310511",
      "ndc_label_name": "CeFAZolin Sodium-Dextrose Solution Reconstituted 2-3 GM-%(50ML) Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264310711",
      "ndc_label_name": "ceFAZolin Sodium-Dextrose Solution Reconstituted 3-2 GM-%(50ML) Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904756304",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039101",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039102",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356003820",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090271900",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781217660",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093316006",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291004360",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063096420",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090271902",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063095920",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090103102",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090271903",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090103101",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090103200",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063095914",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090103103",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090604103",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090103303",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090103300",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090604101",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090604201",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237009960",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063096414",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090103302",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629367103",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090263600",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090103301",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090604102",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180071160",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518253700",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090271901",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629367105",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788832302",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090604100",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687069921",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959013420",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205022420",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934016420",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090604200",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629896801",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189042314",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687069911",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919084020",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629367101",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629367102",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205057614",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187098920",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788733902",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189030814",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919084014",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629367104",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001036206",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054360",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189042320",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205022414",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205057620",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862017760",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788798702",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788760602",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189030820",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788840402",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789005414",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934004420",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789005420",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934006220",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789006120",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781607761",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781607746",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862021860",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093413664",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093413673",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039201",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187083500",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090425800",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090641700",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862021801",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072210",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039202",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072205",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189018532",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072220",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054788",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356011960",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054798",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189004232",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072204",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093413773",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781607861",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090617100",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039302",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090581100",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090372300",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093413764",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781607846",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090372500",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039301",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189018632",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187061600",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072304",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862021901",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356019000",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090102700",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072305",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090273500",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054888",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862021960",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788784401",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788865501",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090102800",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090558300",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054898",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205040560",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205038000",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788706201",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205040500",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189025932",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205038060",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189004332",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338130141",
      "ndc_label_name": "Cefepime HCl SOLUTION 1 GM/50ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338130148",
      "ndc_label_name": "Cefepime HCl SOLUTION 2 GM/100ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143938201",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614600",
      "ndc_label_name": "Cefepime HCl SOLUTION RECONSTITUTED 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143938210",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021012120",
      "ndc_label_name": "Cefepime HCl SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409956610",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567024010",
      "ndc_label_name": "Cefepime HCl SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781322295",
      "ndc_label_name": "Cefepime HCl SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614604",
      "ndc_label_name": "Cefepime HCl SOLUTION RECONSTITUTED 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794020902",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505624500",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409956601",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021012166",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781322280",
      "ndc_label_name": "Cefepime HCl SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008902",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614400",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505624504",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567013010",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614404",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794020941",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032620",
      "ndc_label_name": "Cefepime HCl SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323032621",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288000815",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594008901",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409973510",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143938310",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781322395",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021012250",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143938301",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409973501",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594009002",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034020",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614700",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781322391",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614504",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567024110",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505624600",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021012267",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614704",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021002",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505624604",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567013110",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034021",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614500",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594009001",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021041",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288000920",
      "ndc_label_name": "Cefepime HCl Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264319311",
      "ndc_label_name": "Cefepime-Dextrose Solution Reconstituted 1-5 GM-%(50ML) Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264319511",
      "ndc_label_name": "Cefepime-Dextrose Solution Reconstituted 2-5 GM-%(50ML) Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180042311",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518274901",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877058433",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180042308",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518274902",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518322102",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877058450",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518274904",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518274900",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518322100",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518322101",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518322103",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518322104",
      "ndc_label_name": "Cefixime Capsule 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714076601",
      "ndc_label_name": "Cefixime Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862075150",
      "ndc_label_name": "Cefixime SUSPENSION RECONSTITUTED 100 MG/5ML ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040501",
      "ndc_label_name": "Cefixime Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598067350",
      "ndc_label_name": "Cefixime Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598067451",
      "ndc_label_name": "Cefixime Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714076701",
      "ndc_label_name": "Cefixime Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714076702",
      "ndc_label_name": "Cefixime Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862075250",
      "ndc_label_name": "Cefixime SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040703",
      "ndc_label_name": "Cefixime Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598067450",
      "ndc_label_name": "Cefixime Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040704",
      "ndc_label_name": "Cefixime Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862075275",
      "ndc_label_name": "Cefixime SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980043001",
      "ndc_label_name": "Cefixime Tablet 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121097655",
      "ndc_label_name": "Cefotan Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121097610",
      "ndc_label_name": "Cefotan Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52565005201",
      "ndc_label_name": "Cefotan Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52565005210",
      "ndc_label_name": "Cefotan Solution Reconstituted 1 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121097710",
      "ndc_label_name": "Cefotan Solution Reconstituted 2 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121097755",
      "ndc_label_name": "Cefotan Solution Reconstituted 2 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52565005310",
      "ndc_label_name": "Cefotan Solution Reconstituted 2 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52565005301",
      "ndc_label_name": "Cefotan Solution Reconstituted 2 GM Injection",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "21586001201",
      "ndc_label_name": "Cefotaxime Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "21586001202",
      "ndc_label_name": "Cefotaxime Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "21586012002",
      "ndc_label_name": "Cefotaxime Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323038510",
      "ndc_label_name": "cefoTEtan Disodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323038501",
      "ndc_label_name": "cefoTEtan Disodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323038601",
      "ndc_label_name": "cefoTEtan Disodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323038620",
      "ndc_label_name": "cefoTEtan Disodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034129",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143987825",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143987801",
      "ndc_label_name": "CefOXitin Sodium Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567024525",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010910",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034125",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034101",
      "ndc_label_name": "CefOXitin Sodium Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567024585",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034141",
      "ndc_label_name": "CefOXitin Sodium Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567024710",
      "ndc_label_name": "cefOXitin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143987610",
      "ndc_label_name": "cefOXitin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021011199",
      "ndc_label_name": "cefOXitin Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143987701",
      "ndc_label_name": "CefOXitin Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034225",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143987725",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567024685",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021011020",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567024625",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034229",
      "ndc_label_name": "CefOXitin Sodium SOLUTION RECONSTITUTED 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034201",
      "ndc_label_name": "CefOXitin Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034241",
      "ndc_label_name": "CefOXitin Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264312311",
      "ndc_label_name": "CefOXitin Sodium-Dextrose Solution Reconstituted 1-4 GM-%(50ML) Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264312511",
      "ndc_label_name": "CefOXitin Sodium-Dextrose Solution Reconstituted 2-2.2 GM-%(50ML) Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714040302",
      "ndc_label_name": "Cefpodoxime Proxetil Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980040350",
      "ndc_label_name": "Cefpodoxime Proxetil Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714040301",
      "ndc_label_name": "Cefpodoxime Proxetil Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014101",
      "ndc_label_name": "Cefpodoxime Proxetil Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980040310",
      "ndc_label_name": "Cefpodoxime Proxetil Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014150",
      "ndc_label_name": "Cefpodoxime Proxetil Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014050",
      "ndc_label_name": "Cefpodoxime Proxetil Suspension Reconstituted 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862014001",
      "ndc_label_name": "Cefpodoxime Proxetil Suspension Reconstituted 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714040201",
      "ndc_label_name": "Cefpodoxime Proxetil Suspension Reconstituted 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714040202",
      "ndc_label_name": "Cefpodoxime Proxetil Suspension Reconstituted 50 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862009501",
      "ndc_label_name": "Cefpodoxime Proxetil TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781543820",
      "ndc_label_name": "Cefpodoxime Proxetil TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877055920",
      "ndc_label_name": "Cefpodoxime Proxetil Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959079610",
      "ndc_label_name": "Cefpodoxime Proxetil Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862009520",
      "ndc_label_name": "Cefpodoxime Proxetil TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039401",
      "ndc_label_name": "Cefpodoxime Proxetil TABLET 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877087820",
      "ndc_label_name": "Cefpodoxime Proxetil Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407008320",
      "ndc_label_name": "Cefpodoxime Proxetil Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69292051001",
      "ndc_label_name": "Cefpodoxime Proxetil Tablet 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781543920",
      "ndc_label_name": "Cefpodoxime Proxetil TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862009601",
      "ndc_label_name": "Cefpodoxime Proxetil TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289039302",
      "ndc_label_name": "Cefpodoxime Proxetil Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781543901",
      "ndc_label_name": "Cefpodoxime Proxetil TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862009620",
      "ndc_label_name": "Cefpodoxime Proxetil TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039501",
      "ndc_label_name": "Cefpodoxime Proxetil TABLET 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877087920",
      "ndc_label_name": "Cefpodoxime Proxetil Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407008420",
      "ndc_label_name": "Cefpodoxime Proxetil Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877056020",
      "ndc_label_name": "Cefpodoxime Proxetil Tablet 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039601",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003450",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003475",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862009901",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304096003",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039602",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304096001",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862009975",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039603",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040102",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040101",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040103",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003401",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304096101",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039702",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090322600",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039701",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003501",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010075",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003550",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039703",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010001",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040202",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040201",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003575",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040203",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304014801",
      "ndc_label_name": "Cefprozil TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724703",
      "ndc_label_name": "Cefprozil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093107701",
      "ndc_label_name": "Cefprozil TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877024401",
      "ndc_label_name": "Cefprozil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040301",
      "ndc_label_name": "Cefprozil TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862006801",
      "ndc_label_name": "Cefprozil TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003601",
      "ndc_label_name": "Cefprozil TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039801",
      "ndc_label_name": "Cefprozil TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724720",
      "ndc_label_name": "Cefprozil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090173900",
      "ndc_label_name": "Cefprozil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039901",
      "ndc_label_name": "Cefprozil TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724620",
      "ndc_label_name": "Cefprozil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003750",
      "ndc_label_name": "Cefprozil TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093107853",
      "ndc_label_name": "Cefprozil TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959030020",
      "ndc_label_name": "Cefprozil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862006901",
      "ndc_label_name": "Cefprozil TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304014901",
      "ndc_label_name": "Cefprozil TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862006950",
      "ndc_label_name": "Cefprozil TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877024350",
      "ndc_label_name": "Cefprozil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090171000",
      "ndc_label_name": "Cefprozil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304014950",
      "ndc_label_name": "Cefprozil TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040401",
      "ndc_label_name": "Cefprozil TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144031850",
      "ndc_label_name": "CefTAZidime POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021012720",
      "ndc_label_name": "CefTAZidime SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567023525",
      "ndc_label_name": "CefTAZidime SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021012766",
      "ndc_label_name": "CefTAZidime Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021012867",
      "ndc_label_name": "cefTAZidime Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021012850",
      "ndc_label_name": "cefTAZidime Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567023610",
      "ndc_label_name": "cefTAZidime Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021012969",
      "ndc_label_name": "cefTAZidime Solution Reconstituted 6 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021012999",
      "ndc_label_name": "cefTAZidime Solution Reconstituted 6 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567023706",
      "ndc_label_name": "cefTAZidime Solution Reconstituted 6 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779237003",
      "ndc_label_name": "CefTAZidime with Sod Carbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779237009",
      "ndc_label_name": "CefTAZidime with Sod Carbonate POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338500241",
      "ndc_label_name": "CefTRIAXone Sodium in Dextrose SOLUTION 20 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338500341",
      "ndc_label_name": "CefTRIAXone Sodium in Dextrose SOLUTION 40 MG/ML Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779238303",
      "ndc_label_name": "CefTRIAXone Sodium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779238300",
      "ndc_label_name": "CefTRIAXone Sodium POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733201",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985725",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733221",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733211",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985701",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781320885",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567070125",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021302",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781320895",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010610",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567070195",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180063310",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733220",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021342",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679098301",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330000301",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323034610",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090094501",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614804",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518016800",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010667",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090271200",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330000310",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518249900",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572006125",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090381000",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518309900",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090381001",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090094500",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518309901",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205054501",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518335500",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614800",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518335501",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679098302",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572006101",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180063301",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518249901",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594009602",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 1 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733304",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733331",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733349",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733311",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 1 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330000501",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 1 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505615005",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010899",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594009801",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733410",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143967801",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733420",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021515",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781321046",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567070301",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010869",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 10 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733521",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985625",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733503",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010720",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733513",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985601",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567070225",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330000401",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021402",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733520",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781320995",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330000410",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010768",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614904",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679070301",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594009702",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180064401",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781320990",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572006201",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021442",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567070295",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572006225",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505614900",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679070302",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180064410",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 2 GM Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330000601",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733604",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733611",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 2 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733711",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733721",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021102",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330000101",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985901",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985925",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781320685",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090244400",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733701",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330000110",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090187500",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505615101",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679070101",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733720",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679070103",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594009402",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205011701",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781320695",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180061101",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505615104",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679070102",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021142",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180061110",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 250 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090262800",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505615204",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733821",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733820",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733801",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781320785",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44567070025",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985801",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090383800",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679070201",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010566",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180062210",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021010510",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781320795",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090344700",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985825",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505615201",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021242",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66794021202",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409733811",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518230101",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090094400",
      "ndc_label_name": "CefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518230100",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679070202",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330000201",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180062201",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70594009502",
      "ndc_label_name": "cefTRIAXone Sodium Solution Reconstituted 500 MG Injection",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68330000210",
      "ndc_label_name": "CefTRIAXone Sodium SOLUTION RECONSTITUTED 500 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264315311",
      "ndc_label_name": "CefTRIAXone Sodium-Dextrose Solution Reconstituted 1-3.74 GM-%(50ML) Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264315511",
      "ndc_label_name": "CefTRIAXone Sodium-Dextrose Solution Reconstituted 2-2.22 GM-%(50ML) Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090078100",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714040001",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407033320",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714040002",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904754210",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724503",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090078103",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724504",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090215900",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090699901",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002027520",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063062314",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090215803",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063058420",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090215800",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063065614",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090766700",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237005820",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629944601",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090699900",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090709503",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063065760",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237005860",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063065720",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407033360",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629944701",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877021520",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090709500",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919014520",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429065620",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429065660",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090215901",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919074720",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679092102",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687027211",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090766701",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187099120",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862069920",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919004420",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687027294",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180030260",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679092101",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862069960",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877021560",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180030220",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629944901",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090415300",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959093920",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090215700",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877021620",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714040101",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070020",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714040102",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687028311",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090766801",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877021660",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090766800",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679092202",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407033420",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788890502",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407033460",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070060",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237005960",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934008820",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518269400",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959093930",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002026720",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629356201",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518321500",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687028394",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237005920",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629944801",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789003514",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629356202",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429065720",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180030320",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789003520",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429065760",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679092201",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180030360",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789003560",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143956701",
      "ndc_label_name": "Cefuroxime Sodium Solution Reconstituted 1.5 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143956725",
      "ndc_label_name": "Cefuroxime Sodium Solution Reconstituted 1.5 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143997722",
      "ndc_label_name": "Cefuroxime Sodium Solution Reconstituted 1.5 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143997790",
      "ndc_label_name": "Cefuroxime Sodium Solution Reconstituted 1.5 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021011920",
      "ndc_label_name": "Cefuroxime Sodium Solution Reconstituted 1.5 GM Intravenous",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143956801",
      "ndc_label_name": "Cefuroxime Sodium SOLUTION RECONSTITUTED 750 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143956825",
      "ndc_label_name": "Cefuroxime Sodium SOLUTION RECONSTITUTED 750 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021011810",
      "ndc_label_name": "Cefuroxime Sodium SOLUTION RECONSTITUTED 750 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143997990",
      "ndc_label_name": "Cefuroxime Sodium SOLUTION RECONSTITUTED 750 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143997922",
      "ndc_label_name": "Cefuroxime Sodium SOLUTION RECONSTITUTED 750 MG INJECTION",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054014",
      "ndc_label_name": "CeleBREX Capsule 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054020",
      "ndc_label_name": "CeleBREX Capsule 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025152034",
      "ndc_label_name": "CeleBREX Capsule 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025152031",
      "ndc_label_name": "CeleBREX Capsule 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58151008301",
      "ndc_label_name": "CeleBREX Capsule 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054015",
      "ndc_label_name": "CeleBREX Capsule 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054021",
      "ndc_label_name": "CeleBREX Capsule 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054030",
      "ndc_label_name": "CeleBREX Capsule 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054040",
      "ndc_label_name": "CeleBREX Capsule 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58151008305",
      "ndc_label_name": "CeleBREX Capsule 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054060",
      "ndc_label_name": "CeleBREX Capsule 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025152051",
      "ndc_label_name": "CeleBREX Capsule 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959054028",
      "ndc_label_name": "CeleBREX Capsule 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58151008332",
      "ndc_label_name": "CeleBREX Capsule 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58151008388",
      "ndc_label_name": "CeleBREX Capsule 100 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004614",
      "ndc_label_name": "CeleBREX CAPSULE 100 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004620",
      "ndc_label_name": "CeleBREX CAPSULE 100 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004660",
      "ndc_label_name": "CeleBREX CAPSULE 100 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004630",
      "ndc_label_name": "CeleBREX CAPSULE 100 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959053928",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "12634083471",
      "ndc_label_name": "CeleBREX CAPSULE 200 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025152531",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440724030",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959053945",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025152551",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025152534",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959053900",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959053940",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959053920",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629302102",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959053907",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289047510",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959053914",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959053905",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289047514",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959053990",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959053921",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629302103",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959053910",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58151008432",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289047520",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959053930",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919004660",
      "ndc_label_name": "CeleBREX CAPSULE 200 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919004630",
      "ndc_label_name": "CeleBREX CAPSULE 200 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629302104",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629302105",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959053915",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004710",
      "ndc_label_name": "CeleBREX CAPSULE 200 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289047593",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959053950",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629302108",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004807",
      "ndc_label_name": "CeleBREX CAPSULE 200 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629302106",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959053960",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289047560",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289047530",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58151008401",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289047590",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629302110",
      "ndc_label_name": "CeleBREX CAPSULE 200 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58151008405",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629302107",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004820",
      "ndc_label_name": "CeleBREX CAPSULE 200 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629302101",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58151008488",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004715",
      "ndc_label_name": "CeleBREX CAPSULE 200 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629302109",
      "ndc_label_name": "CeleBREX Capsule 200 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004856",
      "ndc_label_name": "CeleBREX CAPSULE 200 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004815",
      "ndc_label_name": "CeleBREX CAPSULE 200 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004830",
      "ndc_label_name": "CeleBREX CAPSULE 200 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004810",
      "ndc_label_name": "CeleBREX CAPSULE 200 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267004860",
      "ndc_label_name": "CeleBREX CAPSULE 200 MG ORAL",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58151008588",
      "ndc_label_name": "CeleBREX Capsule 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025153001",
      "ndc_label_name": "CeleBREX Capsule 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025153002",
      "ndc_label_name": "CeleBREX Capsule 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959090430",
      "ndc_label_name": "CeleBREX Capsule 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58151008591",
      "ndc_label_name": "CeleBREX Capsule 400 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025151501",
      "ndc_label_name": "CeleBREX Capsule 50 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58151008291",
      "ndc_label_name": "CeleBREX Capsule 50 MG Oral",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904650261",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342015615",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571014305",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378716001",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27808029601",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093716501",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27808029602",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093716505",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714073202",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700061330",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090638001",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668044101",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806072105",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591398305",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700061360",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378716005",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762151601",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429046001",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436398301",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342015611",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228015701",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788011305",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505384805",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591398301",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429046005",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919004560",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505384801",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806072101",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268016811",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571014301",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760082330",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788011301",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760082360",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117002103",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687043601",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090638000",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436398201",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436790101",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919068260",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668044105",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788728606",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420024360",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760064930",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228015705",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760020960",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079019901",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788728609",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714073201",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097042212",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084320",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862090805",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268016815",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760099560",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687043611",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820609",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079019920",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117002102",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425014202",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097042207",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762151603",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919004530",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760064960",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335029201",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760099530",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205043960",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919004360",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69399018381",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919004330",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135002160",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332014131",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335201901",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332014171",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335180403",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187064360",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205002060",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187030160",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180039601",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739029710",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72241002310",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367030105",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335180404",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788728603",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335029203",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862090801",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180039602",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820606",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420024301",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205043930",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335222204",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518274800",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335093605",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367030101",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788820603",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335093606",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072701",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335222203",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71626030205",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335180401",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335180405",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518292200",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335093603",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335201903",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072707",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71626030230",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189012390",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71626030201",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335222201",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518292201",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834023705",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420024307",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425016701",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189012360",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084307",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420024330",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072705",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335093601",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072730",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420024390",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425032101",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072714",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425032103",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084305",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084301",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335093604",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084390",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084314",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425032303",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072760",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804015160",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084330",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81288002130",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162225405",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771015701",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425016702",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008007530",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072790",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301001101",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "85509123703",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "85509123709",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189012330",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425032102",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "85509123706",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425032301",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084300",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009006805",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189012372",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "85509123701",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084310",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72241002305",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425014201",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834023701",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81288002120",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072710",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008007560",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072720",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301001102",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084360",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771015705",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425032302",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378715005",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093716605",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093716601",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714073302",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591398405",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378715001",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788011401",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904650361",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668044201",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063066910",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591398401",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342015715",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668044205",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090517802",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27808029701",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788011405",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063066930",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063066960",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714073301",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571014401",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063066920",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090675802",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063096714",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27808029702",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082510",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090563802",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342015711",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806072205",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082560",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436014402",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353025753",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063096760",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082530",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429046105",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571014405",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082514",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090242700",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436384902",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090242701",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090657702",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353003630",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919083760",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806072201",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063096730",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090478900",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436398402",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090675800",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090707200",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090563800",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135002260",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063066914",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090318301",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090517800",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505384905",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228015805",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228015801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090563801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332014271",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353025730",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090318302",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090517801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760074215",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268016911",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268016915",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090657700",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629550302",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353025760",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436384901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090675801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135002201",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436014401",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436398401",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090657701",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097042112",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090318300",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700060760",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700060714",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180039901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436770101",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762151703",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079021501",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117002203",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090478901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687044711",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762151701",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788726406",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436770102",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429046101",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919036015",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69677015460",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090478902",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760082415",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760074230",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788867906",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505384901",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919016830",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187063330",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69677015490",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090675900",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919036010",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760074260",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788867909",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760082430",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919036030",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629550303",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518320400",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079021520",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919083710",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919016860",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205002730",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760082460",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919036042",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862090901",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518329201",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700060730",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919083790",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919036060",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335106601",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187056260",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332014231",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788773509",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205002760",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687044701",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332014291",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919083730",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335222001",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862090905",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629550304",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788819709",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205005530",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919083742",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739029810",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788726401",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610058430",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788726403",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788773501",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367030205",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71626030305",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187056230",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788867901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367030201",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162242101",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788726409",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788819701",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518134600",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162217503",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187063360",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69399018485",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205005560",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72241002410",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69680013500",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788819703",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518134601",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189036030",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629550301",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518329200",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335086802",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420071401",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518134602",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788819706",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518373301",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789025914",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788773503",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518417501",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335106602",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084410",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518329202",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788867903",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518373302",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420071407",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788773506",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335245601",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162235705",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084414",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335245604",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69677015415",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335086801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425003802",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788773508",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610028330",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162238001",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425003702",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610028353",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205002714",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335222002",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81288002230",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788819708",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162242105",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162248905",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425009601",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162217506",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205002790",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084420",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804021314",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788867908",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834023801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420000930",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425020901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189036090",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205066430",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084460",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301001202",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097042107",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420000901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420000960",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425038202",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789025960",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205066490",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084490",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009006905",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117002202",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420000907",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420071414",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008001330",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420071420",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335106606",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425003801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008001360",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69399018481",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420071405",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420071430",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301001201",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084405",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610058453",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084400",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "85509115801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69399019485",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771015805",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084407",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71626030301",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425009603",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425038201",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084412",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162238005",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69677015401",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189036042",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425003701",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72241002405",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425020904",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789025930",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425003902",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420071410",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69677015430",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084401",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425020902",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084430",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028101",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425009602",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425038203",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425020903",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518373303",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028102",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804021360",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804021390",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028103",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934002614",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425028104",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205066414",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804021330",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205066460",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335106603",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335245602",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610028360",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610058460",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71626030330",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162217505",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162248901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189036010",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189036060",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834023805",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420071460",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420071490",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771015801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425003901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425004001",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425004002",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81288002220",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "85509115803",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "85509115806",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788011560",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668031001",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117002302",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228015960",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714073401",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806072360",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093717006",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378717091",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668031005",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342015809",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771015960",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135002360",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097042003",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332014360",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591398560",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571014560",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117002303",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762151802",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668031060",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834023960",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69399018581",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072814",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862091060",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180039807",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072801",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429046260",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117002301",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084514",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072860",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084560",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72241002503",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072890",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084505",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072820",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072807",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084520",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084590",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81288002360",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084501",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072830",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084507",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084530",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429045960",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788011260",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591398260",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093730606",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668030760",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378716591",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834023660",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806072060",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180039507",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762151501",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69117002001",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714073101",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332014060",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342015509",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072690",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505384706",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71626030101",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084201",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69399018281",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27808029501",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072620",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71626030160",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084220",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072601",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71626030130",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084207",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072607",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571014260",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072630",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084200",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072614",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084290",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72241002203",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084214",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084230",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228015660",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420072660",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862090760",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420084260",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097042303",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "77771015660",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83301002801",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927506300",
      "ndc_label_name": "Celecoxib Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46144011810",
      "ndc_label_name": "Celecoxib POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552146104",
      "ndc_label_name": "Celecoxib POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552146105",
      "ndc_label_name": "Celecoxib POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552146106",
      "ndc_label_name": "Celecoxib POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68981002501",
      "ndc_label_name": "Celecoxib Powder",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552146107",
      "ndc_label_name": "Celecoxib POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70175021901",
      "ndc_label_name": "Celecoxib POWDER",
      "drug_tier": "Non-Preferred",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68981002502",
      "ndc_label_name": "Celecoxib Powder",
      "drug_tier": "Non-Preferred",
      "pr